Department of Medicine, McMaster University and Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada.
Best Pract Res Clin Haematol. 2012 Sep;25(3):361-77. doi: 10.1016/j.beha.2012.06.003. Epub 2012 Aug 2.
The past decade has witnessed important advances in the diagnosis and treatment of venous thromboembolism with excellent opportunities to apply evidence-based medicine for many of the steps in the management of the disease. This review discusses the clinical prediction rules that should be used to reduce utilization of imaging diagnosis for deep vein thrombosis or pulmonary embolism and the risk stratification for thrombolytic therapy or outpatient management of pulmonary embolism. The treatment options have increased and include low-molecular-weight heparin (LMWH), intravenous or subcutaneous unfractionated heparin - the latter either monitored or not monitored, fondaparinux and rivaroxaban for the initial phase. Thereafter, vitamin K antagonists (VKAs), LMWH, oral factor Xa or thrombin inhibitors are or will soon become available. The VKAs have been subjected to many randomised trial addressing the initiation, intensity, monitoring and self-management. Extended anticoagulation and the selection for that is finally reviewed.
过去十年见证了静脉血栓栓塞症诊断和治疗方面的重要进展，为疾病管理的许多步骤应用循证医学提供了极好的机会。这篇综述讨论了应该使用哪些临床预测规则来减少对深静脉血栓形成或肺栓塞的影像学诊断的利用，以及对溶栓治疗或肺栓塞的门诊管理的风险分层。治疗选择增加了，包括低分子量肝素（LMWH）、静脉或皮下普通肝素-后者可以监测或不监测、磺达肝癸钠和利伐沙班用于初始阶段。此后，维生素 K 拮抗剂（VKA）、LMWH、口服因子 Xa 或凝血酶抑制剂可用或即将可用。VKA 已经进行了许多随机试验，涉及起始、强度、监测和自我管理。最后回顾了延长抗凝和选择的问题。
