Burgazlı K Mehmet, Bilgin Mehmet, Kavukçu Ethem, Altay M Metin, Ozkan H Turhan, Coşkun Uğur, Akdere Hakan, Ertan A Kubilay
Clinic of Internal Medicine, Cardiology, Angiology, University Giessen, Giessen, Germany ; Department of Internal Medicine, Phlebologie, Medical Center Wuppertal, Wuppertal, Germany.
Clinic of Internal Medicine, Cardiology, Angiology, University Giessen, Giessen, Germany.
J Turk Ger Gynecol Assoc. 2011 Sep 1;12(3):168-75. doi: 10.5152/jtgga.2011.39. eCollection 2011.
Deep vein thrombosis (DVT) is a common condition in which the approach to its diagnosis has evolved over the years. Currently, an algorithm strategy combining pre-test probability, D-Dimer testing and compression ultrasound imaging allows for safe and convenient investigation of suspected lower-extremity thrombosis. Patients with low pre-test probability and a negative D-Dimer test result can have proximal DVT excluded without the need for diagnostic imaging. The mainstay of treatment of DVT is anticoagulation therapy, whereas interventions such as thrombolysis and placement of inferior vena cava filters are reserved for special situations. The use of low-molecular-weight heparin (LMW) allows for outpatient management of most patients with DVT. The duration of anticoagulation therapy depends on whether the primary event was idiopathic or secondary to a transient risk factor. More research is required to optimally define the factors that predict an increased risk of recurrent DVT to determine which patients can benefit from extended anticoagulant therapy. DVT is also a serious problem in the antenatal and postpartum period of pregnancy. Thromboembolic complications are the leading cause of both maternal and fetal morbidity and mortality. The incidence of venous thromboembolism during normal pregnancy is six-fold higher than in the general female population of childbearing age. The treatment of DVT during pregnancy deserves special mention, since oral anticoagulation therapy is generally avoided during pregnancy because of the teratogenic effects in the first trimester and the risk of fetal intracranial bleeding in the third trimester. LMW heparin is the treatment of choice for DVT during pregnancy. If acute DVT occurs near term, interrupting anticoagulation therapy may be hazardous because of the risk of pulmonary embolism. In this situation, placement of a retrievable inferior vena cava filter must be considered. However, there is no consensus as to what the appropriate dose should be and whether anti-Xa levels need to be monitored.
深静脉血栓形成（DVT）是一种常见病症，其诊断方法多年来不断发展。目前，一种结合了预测试概率、D - 二聚体检测和加压超声成像的算法策略，能够安全便捷地对疑似下肢血栓形成进行检查。预测试概率低且D - 二聚体检测结果为阴性的患者，无需进行诊断性成像即可排除近端DVT。DVT治疗的主要方法是抗凝治疗，而诸如溶栓和下腔静脉滤器置入等干预措施则用于特殊情况。使用低分子量肝素（LMW）可使大多数DVT患者在门诊接受治疗。抗凝治疗的持续时间取决于原发性事件是特发性的还是继发于短暂风险因素。需要更多研究来优化定义预测复发性DVT风险增加的因素，以确定哪些患者可从延长抗凝治疗中获益。DVT在妊娠的产前和产后阶段也是一个严重问题。血栓栓塞并发症是孕产妇和胎儿发病及死亡的主要原因。正常妊娠期间静脉血栓栓塞的发生率比育龄期普通女性人群高六倍。孕期DVT的治疗值得特别提及，因为由于孕早期的致畸作用和孕晚期胎儿颅内出血的风险，孕期通常避免使用口服抗凝治疗。LMW肝素是孕期DVT的首选治疗药物
