Couturaud F, Kearon C
EA 3878 (GETBO), département de médecine interne et pneumologie, CHU La Cavale-Blanche, 29609 Brest cedex, France.
Rev Pneumol Clin. 2008 Dec;64(6):305-15. doi: 10.1016/j.pneumo.2008.09.007. Epub 2008 Nov 18.
Vitamin K antagonists are the mainstay for the treatment for venous thromboembolism. The optimum (VTE) course of oral anticoagulant therapy is determined according to the risk of recurrent VTE after stopping anticoagulant therapy and the risk of anticoagulant-related bleeding while on antivitamin K. The risk of recurrent VTE is low when the initial episode is provoked by a reversible major-risk factor (surgery), whereas this risk is high when VTE is not provoked or associated with a persistent-risk factor (cancer). Conversely, the influence of biochemical and morphological tests is uncertain. The optimum balance of the benefits and the risks of oral anticoagulant therapy is based on the frequency as well as the consequences of the risk of recurrent VTE and anticoagulant-related bleeding. After VTE provoked by a major reversible-risk factor, three months of anticoagulation is optimal, whereas after unprovoked VTE, anticoagulation should be extended. However, given the number of unresolved issues, a randomised trial comparing different durations of anticoagulation is needed.
维生素K拮抗剂是治疗静脉血栓栓塞症的主要药物。口服抗凝治疗的最佳疗程是根据停用抗凝治疗后复发性静脉血栓栓塞症的风险以及服用维生素K拮抗剂期间抗凝相关出血的风险来确定的。当初次发作由可逆的主要危险因素（手术）引发时，复发性静脉血栓栓塞症的风险较低，而当静脉血栓栓塞症未被引发或与持续危险因素（癌症）相关时，这种风险则较高。相反，生化和形态学检查的影响尚不确定。口服抗凝治疗的益处与风险的最佳平衡基于复发性静脉血栓栓塞症风险的频率及其后果以及抗凝相关出血的情况。由主要可逆危险因素引发静脉血栓栓塞症后，三个月的抗凝治疗是最佳的，而在无诱因的静脉血栓栓塞症后，抗凝治疗应延长。然而，鉴于仍有许多未解决的问题，需要进行一项比较不同抗凝疗程的随机试验。
