Marcucci Maura, Iorio Alfonso, Douketis James
Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, St. Joseph's Healthcare, F-544, 50 Charlton Ave East, Hamilton, ON, Canada, L8N 4A6.
Curr Treat Options Cardiovasc Med. 2013 Apr;15(2):224-39. doi: 10.1007/s11936-012-0225-2.
The management of patients with unprovoked venous thromboembolism is a common and challenging clinical problem. Although the initial antithrombotic management is well-established, there is uncertainty about the optimal long-term anticoagulant management, specifically whether patients should receive a short (i.e., 3- to 6-month) duration of anticoagulant therapy or indefinite anticoagulation. Factors that may be considered to estimate patients' risk for recurrent thromboembolism include the mode of initial clinical presentation, as deep vein thrombosis or pulmonary embolism, patient sex, antecedent hormonal therapy use, thrombophilia, D-dimer levels, and residual vein occlusion in patients with deep vein thrombosis. Many of these factors have been integrated into clinical prediction guides which stratify patients with unprovoked venous thromboembolism according to their risk for disease recurrence and, thereby, can assist clinicians in decisions about the duration of anticoagulation. The objective of this review is to consider the evidence relating to the clinical significance of purported risk factors and provide a practical case-based approach to guide decisions on duration of anticoagulation for patients with unprovoked venous thromboembolism.
无诱因静脉血栓栓塞患者的管理是一个常见且具有挑战性的临床问题。尽管初始抗栓治疗方案已确立，但最佳长期抗凝治疗方案仍不明确，尤其是患者应接受短期（即3至6个月）抗凝治疗还是长期抗凝治疗。评估患者复发性血栓栓塞风险时可考虑的因素包括初始临床表现形式，如深静脉血栓形成或肺栓塞、患者性别、既往激素治疗使用情况、易栓症、D-二聚体水平以及深静脉血栓形成患者的残余静脉闭塞情况。其中许多因素已被纳入临床预测指南，这些指南根据无诱因静脉血栓栓塞患者疾病复发的风险对其进行分层，从而有助于临床医生决定抗凝治疗的持续时间。本综述的目的是考量与所谓风险因素临床意义相关的证据，并提供一种基于实际病例的方法，以指导无诱因静脉血栓栓塞患者抗凝治疗持续时间的决策。
