Dept. of Angiology & Blood Coagulation, University Hospital of Bologna, Bologna, Italy.
Hamostaseologie. 2012;32(1):40-4. doi: 10.5482/ha-1180. Epub 2011 Oct 19.
Acute venous thromboembolism (VTE) is treated with parenteral administration of heparin or derivatives, in conjunction with oral vitamin K antagonists (VKAs) to reach and maintain INR values between 2.0 and 3.0 for at least 3 months; the duration of a further period of treatment for secondary prevention of recurrences is still matter of debate. If bleeding occurs during treatment the decision will be based on: a) type of bleeding (major or minor), and b) thrombotic risk if anticoagulation is withheld (characteristics of patients and time elapsed from the index VTE). In case of major bleeding anticoagulation should be stopped and reversed. A first but insufficient measure is i.v. vitamin K administration. Fresh frozen plasma is widely used; however, large volumes are needed (at least 15 mL/kg body weight) with risk for fluid overload. Prothrombin complex concentrate infusion, with 3 or (better) the 4 pro-coagulant factors, is a more efficient (fast and safe) measure. In patients at high thrombotic risk (first month or other conditions) and absolute contraindication for anticoagulation a caval filter is recommended, to avoid as much as possible life-threatening pulmonary embolism.
急性静脉血栓栓塞症（VTE）采用静脉内给予肝素或其衍生物，并联合口服维生素 K 拮抗剂（VKA）治疗，以达到并维持 INR 值在 2.0 至 3.0 之间至少 3 个月；用于预防复发的进一步治疗持续时间仍然存在争议。如果在治疗过程中发生出血，则将根据以下因素做出决定：a）出血类型（主要或次要），以及 b）如果停止抗凝治疗时的血栓形成风险（患者特征和从 VTE 发作时间）。如果发生大出血，应停止抗凝并进行逆转。首先但不充分的措施是静脉内给予维生素 K。新鲜冷冻血浆被广泛使用；然而，需要大体积（至少 15 mL/kg 体重），并且存在液体超负荷的风险。含有 3 种（更好是 4 种）促凝因子的凝血酶原复合物输注是一种更有效的（快速且安全）措施。对于高血栓形成风险（第一个月或其他情况）且绝对抗凝禁忌的患者，建议使用腔静脉滤器，以尽可能避免危及生命的肺栓塞。
