当前基层医疗实践中对疑似静脉血栓栓塞症患者的诊断与管理以及依诺肝素起始剂量的处方。

Current primary care practice in the diagnosis and management of patients with suspected venous thromboembolism and prescription of initiation dose of enoxaparin.

作者信息

Verhamme P, Motte S, Claes N, Verhaeghe R, Hermans C

机构信息

Department of Vascular Medicine and Haemostasis, University Hospital Gasthuisberg, Leuven, Belgium.

出版信息

Int Angiol. 2010 Feb;29(1):58-63.

PMID:20224534

Abstract

AIM

Ambulatory care of patients with deep vein thrombosis (DVT) has been well validated but limited data exist on the diagnostic and therapeutic management of venous thromboembolism (VTE) in primary care.

METHODS

A cross-sectional survey on the clinical conditions for the initiation of once daily (OD) enoxaparin and on the diagnostic and therapeutic strategy of VTE in ambulatory patients using a single-visit questionnaire to be filled out by the general practitioner (GP).

RESULTS

Of the 4522 included patients, 2164 (48%) were started on therapeutic OD enoxaparin for confirmed or suspected proximal DVT, 464 (10%) for distal DVT, 493 (11%) for pulmonary embolism (PE), and 742 (16%) for superficial venous thrombosis (SVT). Further indications included bridging of oral anticoagulation in 173 patients (4%), atrial fibrillation in 77 patients (2%) and prevention of VTE in 78 patients (2%). Enoxaparin was initiated on the basis of clinical probability before objective confirmation in 17%, 33%, 53% and 69% of patients with a diagnosis of PE, proximal DVT, distal DVT and SVT, respectively. No objective testing was planned for 3%, 9%, 18% and 41% of patients in these respective categories. Patients were referred to specialist care in 88%, 49%, 42% and 21% of patients with PE, proximal DVT, distal DVT and SVT, respectively.

CONCLUSION

Therapeutic OD enoxaparin is prescribed in primary care for the whole clinical spectrum of VTE. However, the diagnostic work-up is unsatisfactory to suboptimal in a substantial proportion of these patients.

摘要

目的

门诊治疗深静脉血栓形成（DVT）患者已得到充分验证，但关于基层医疗中静脉血栓栓塞症（VTE）诊断和治疗管理的数据有限。

方法

采用单访调查问卷，由全科医生（GP）填写，对启动每日一次（OD）依诺肝素的临床情况以及门诊患者VTE的诊断和治疗策略进行横断面调查。

结果

在纳入的4522例患者中，2164例（48%）因确诊或疑似近端DVT开始接受治疗性OD依诺肝素治疗，464例（10%）因远端DVT，493例（11%）因肺栓塞（PE），742例（16%）因浅静脉血栓形成（SVT）。其他指征包括173例患者（4%）用于口服抗凝的桥接治疗，77例患者（2%）用于房颤，78例患者（2%）用于预防VTE。在诊断为PE、近端DVT、远端DVT和SVT的患者中，分别有17%、33%、53%和69%的患者在客观确诊前根据临床可能性开始使用依诺肝素。在这些相应类别中，分别有3%、9%、18%和41%的患者未计划进行客观检查。分别有88%、49%、42%和21%的PE、近端DVT（深静脉血栓形成）、远端DVT和SVT患者被转诊至专科护理。