Department of Internal Medicine, Piacenza Hospital, Via Taverna 49, Piacenza, Italy.
Semin Respir Crit Care Med. 2012 Apr;33(2):176-85. doi: 10.1055/s-0032-1311796. Epub 2012 May 30.
Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is the third most common cardiovascular pathology after coronary disease and cerebrovascular diseases and is responsible for significant morbidity and mortality in the general population. Full-dose anticoagulation is the standard therapy for VTE, both the acute phase and the prolonged treatment. The latest guidelines of the American College of Chest Physicians recommend treatment with a full-dose of unfractionated heparin (UFH), low-molecular-weight-heparin (LMWH), fondaparinux, vitamin K antagonist (VKA), or systemically administered thrombolytics for most of the patients with objectively confirmed VTE. Catheter-guided thrombolysis and thrombosuction are interventional approaches that should be used only in selected populations; interruption of the inferior vena cava (IVC) with a filter can be performed to prevent life-threatening PE in patients with VTE and contraindications to anticoagulant treatment, bleeding complications during antithrombotic treatment, or VTE recurrences, despite optimal anticoagulation. This review summarizes the currently available literature regarding interventional approaches in VTE treatment (vena cava filters, catheter-guided thrombolysis, thrombosuction), discusses their efficacy and safety, and reviews the appropriate indications for their use in daily clinical practice.
静脉血栓栓塞症（VTE），包括深静脉血栓形成（DVT）和肺栓塞（PE），是继冠心病和脑血管疾病之后的第三大常见心血管病理，在普通人群中导致了显著的发病率和死亡率。全剂量抗凝是 VTE 的标准治疗方法，包括急性期和长期治疗。美国胸科医师学院的最新指南建议，对于大多数经客观证实的 VTE 患者，使用全剂量普通肝素（UFH）、低分子肝素（LMWH）、磺达肝癸钠、维生素 K 拮抗剂（VKA）或全身性溶栓剂进行治疗。导管引导的溶栓和血栓抽吸是介入治疗方法，仅应在特定人群中使用；在 VTE 患者中，为了预防危及生命的 PE，可以使用下腔静脉（IVC）滤器来中断抗凝治疗的禁忌证、抗血栓治疗期间的出血并发症或尽管进行了最佳抗凝治疗仍出现 VTE 复发。这篇综述总结了目前关于 VTE 治疗中介入治疗方法（腔静脉滤器、导管引导的溶栓、血栓抽吸）的可用文献，讨论了它们的疗效和安全性，并回顾了在日常临床实践中使用它们的适当适应证。
