Wells Philip, Anderson David
1Department of Medicine, University of Ottawa and the Ottawa Hospital, Ottawa Hospital Research Institute, Ottawa, ON; and.
Hematology Am Soc Hematol Educ Program. 2013;2013:457-63. doi: 10.1182/asheducation-2013.1.457.
Venous thromboembolism (VTE) is a common condition that can lead to complications such as postphlebitic syndrome, chronic pulmonary artery hypertension, and death. The approach to the diagnosis of has evolved over the years and an algorithm strategy combining pretest probability, D-dimer testing, and diagnostic imaging now allows for safe, convenient, and cost-effective investigation of patients. Patients with low pretest probability and a negative D-dimer can have VTE excluded without the need for imaging. The mainstay of treatment of VTE is anticoagulation, whereas interventions such as thrombolysis and inferior vena cava filters are reserved for special situations. Low-molecular-weight heparin has allowed for outpatient management of most patients with deep vein thrombosis at a considerable cost savings to the health care system. Patients with malignancy-associated VTE benefit from decreased recurrent rates if treated with long-term low-molecular-weight heparin. The development of new oral anticoagulants further simplifies treatment. The duration of anticoagulation is primarily influenced by underlying cause of the VTE (whether provoked or not) and consideration of the risk for major hemorrhage. Testing for genetic and acquired thrombophilia may provide insight as to the cause of a first idiopathic deep vein thrombosis, but the evidence linking most thrombophilias to an increased risk of recurrent thrombosis is limited.
静脉血栓栓塞症（VTE）是一种常见病症，可导致诸如血栓后综合征、慢性肺动脉高压和死亡等并发症。多年来，其诊断方法不断发展，如今一种结合了预检概率、D-二聚体检测和诊断成像的算法策略能够对患者进行安全、便捷且具有成本效益的检查。预检概率低且D-二聚体检测结果为阴性的患者可排除VTE，无需进行成像检查。VTE治疗的主要方法是抗凝，而溶栓和下腔静脉滤器等干预措施则用于特殊情况。低分子量肝素使大多数深静脉血栓形成患者能够在门诊接受治疗，为医疗系统节省了可观的费用。恶性肿瘤相关VTE患者若接受长期低分子量肝素治疗，复发率会降低。新型口服抗凝剂的出现进一步简化了治疗。抗凝持续时间主要受VTE的潜在病因（是否为诱因）以及大出血风险的考虑因素影响。对遗传性和获得性易栓症进行检测可能有助于了解首次特发性深静脉血栓形成的病因，但将大多数易栓症与复发性血栓形成风险增加联系起来的证据有限。
