Department of Internal Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria.
Semin Respir Crit Care Med. 2012 Apr;33(2):186-90. doi: 10.1055/s-0032-1311797. Epub 2012 May 30.
Immediate intense anticoagulation with parenteral anticoagulants (heparin or fondaparinux) followed by vitamin K antagonists is the current standard therapy for deep vein thrombosis (DVT) or nonmassive pulmonary embolism. In the future, new oral anticoagulants may replace not only vitamin K antagonists but also initial parenteral anticoagulation. Duration of anticoagulation should be at least 3 months because shorter courses double the recurrence rates. More prolonged anticoagulation therapy may be warranted in the presence of specific clinical risk factors. Global markers of coagulation, particularly D-dimer, may discriminate low- and high-risk patients. Models that combine clinical characteristics and laboratory markers further improve prediction of the recurrence risk in individual patients, but these models await validation before they can be applied in routine care.
立即给予静脉用抗凝剂（肝素或磺达肝癸钠）进行强化抗凝，随后给予维生素 K 拮抗剂，这是目前深静脉血栓形成（DVT）或非大面积肺栓塞的标准治疗方法。将来，新型口服抗凝剂可能不仅取代维生素 K 拮抗剂，而且还取代初始的静脉用抗凝剂。抗凝治疗的持续时间至少应为 3 个月，因为较短的疗程会使复发率增加一倍。在存在特定临床危险因素的情况下，可能需要更长期的抗凝治疗。凝血的全局标志物，特别是 D-二聚体，可区分低危和高危患者。将临床特征和实验室标志物相结合的模型可进一步提高对个体患者复发风险的预测能力，但在这些模型能够常规应用于临床之前，还需要对其进行验证。
