Imberti Davide, Benedetti Raffaella, Ageno Walter
Internal Medicine Department, Haemostasis and Thrombosis Center, Piacenza Hospital, Via Taverna 49, 29121, Piacenza, Italy,
Intern Emerg Med. 2013 Dec;8(8):667-72. doi: 10.1007/s11739-013-0979-x. Epub 2013 Jul 16.
Venous thromboembolism (VTE) is a common potentially life-threatening complication in acutely ill medical patients; over 70 % of the fatal episodes of pulmonary embolism during hospitalization occur in non-surgical patients. In the absence of thromboprophylaxis, the incidence of venographically detected deep vein thrombosis is about 15 % in medical patients. Several trials and meta-analyses have clearly demonstrated the prophylactic role of unfractionated heparin, low molecular weight heparin and fondaparinux. Although over the past few years the knowledge of epidemiology, clinical features and prophylaxis in medical patients has significantly improved, there remain a number of controversial areas that require further investigation. Newer VTE risk assessment models have been proposed to select high risk hospitalized medical patients, but they still require external validation; scarce data are available to stratify patients to identify their individual bleeding risk. The optimal duration of thromboprophylaxis in medical patients is still a matter of debate; currently, extended prophylaxis after discharge is not recommended, but it may be required for subgroup of patients with persistently high VTE risk and a negligible risk of bleeding. Based on the results of recent studies, the new oral anticoagulants appear to have a very limited role, if any. However, a better risk stratification of patients who have a persistently increased risk of VTE is warranted to improve the risk to benefit profile of any anticoagulant drug to be used in this setting.
静脉血栓栓塞症（VTE）是急性病患者常见的一种潜在危及生命的并发症；住院期间超过70%的致命性肺栓塞事件发生在非手术患者中。在未进行血栓预防的情况下，内科患者经静脉造影检测到的深静脉血栓形成发生率约为15%。多项试验和荟萃分析已明确证实了普通肝素、低分子肝素和磺达肝癸钠的预防作用。尽管在过去几年中，内科患者的流行病学、临床特征和预防方面的知识有了显著提高，但仍有一些有争议的领域需要进一步研究。已提出了更新的VTE风险评估模型来筛选住院的高危内科患者，但它们仍需外部验证；目前缺乏数据对患者进行分层以确定其个体出血风险。内科患者血栓预防的最佳持续时间仍存在争议；目前，不建议出院后延长预防，但对于VTE风险持续较高且出血风险可忽略不计的患者亚组可能需要延长预防。基于近期研究结果，新型口服抗凝药即便有作用，似乎也非常有限。然而，对VTE风险持续增加的患者进行更好的风险分层，对于改善在此情况下使用的任何抗凝药物的风险效益比是必要的。
