Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Internal Medicine and Medical Specialities, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy.
Best Pract Res Clin Haematol. 2012 Sep;25(3):265-74. doi: 10.1016/j.beha.2012.07.003. Epub 2012 Aug 11.
Venous thrombosis typically involves the lower extremities. Rarely, it can occur in cerebral, splanchnic, or renal veins, with a frightening clinical impact. Other rare manifestations are upper-extremity deep vein thrombosis, that can complicate with pulmonary embolism and post-thrombotic syndrome, and retinal vein occlusion, significantly affecting the quality of life. This review is focused on venous thromboses at unusual extra-abdominal sites. Local infections or cancer are frequent in cerebral sinus-venous thrombosis. Upper-extremity deep vein thrombosis is mostly due to catheters or effort-related factors. Common risk factors are inherited thrombophilia and oral contraceptive use. Acute treatment is based on heparin; in cerebral sinus-venous thrombosis, local or systemic fibrinolysis should be considered in case of clinical deterioration. Vitamin-K antagonists are recommended for 3-6 months; indefinite anticoagulation is suggested for recurrent thrombosis or unprovoked thrombosis and permanent risk factors. However, such recommendations mainly derive from observational studies; there are no data about long-term treatment of retinal vein occlusion.
静脉血栓形成通常涉及下肢。很少发生在脑、内脏或肾静脉,具有可怕的临床影响。其他罕见的表现为上肢深静脉血栓形成,可并发肺栓塞和血栓后综合征,以及视网膜静脉阻塞,显著影响生活质量。本文主要关注腹部外不常见部位的静脉血栓形成。脑窦静脉血栓形成中局部感染或癌症很常见。上肢深静脉血栓形成主要是由于导管或与用力相关的因素引起的。常见的危险因素包括遗传性血栓形成倾向和口服避孕药的使用。急性治疗基于肝素;如果出现临床恶化,应考虑脑窦静脉血栓形成中局部或全身溶栓治疗。维生素 K 拮抗剂推荐使用 3-6 个月;对于复发性血栓形成或无诱因性血栓形成和永久性危险因素,建议长期抗凝治疗。然而,这些建议主要来自观察性研究;关于视网膜静脉阻塞的长期治疗尚无数据。