Righini Marc, Le Gal Grégoire, Bounameaux Henri
Marc Righini, MD, Division of Angiology and Hemostasis, Department of Medical Specialties, Geneva University Hospital and Faculty of Medicine, 4, rue Gabrielle-Perret-Gentil, CH-1211 Geneva 14, Switzerland, Tel.: +41 22 372 92 94, Fax. +41 22 372 92 99, E-mail:
Thromb Haemost. 2015 Jun;113(6):1184-92. doi: 10.1160/TH14-06-0530. Epub 2014 Dec 11.
Recent advances in the management of patients with suspected VTE have both improved diagnostic accuracy and made management algorithms safer, easier to use and well standardised. These diagnostic algorithms are mainly based on the assessment of clinical pretest probability, D-dimer measurement and imaging tests, mainly represented by compression ultrasound (CUS) for suspected DVT and computed tomography pulmonary angiography (CTPA) or lung ventilation-perfusion scan for pulmonary embolism. These diagnostic algorithms allow a safe and cost-effective diagnosis for most patients with suspected VTE. In this review, we focus on the challenge of diagnosing VTE in special patient populations, such as elderly patients, pregnant women, or patients with a prior VTE. Some additional challenges are arising that might require adjustments to current diagnostic strategies, such as the reduced clinical suspicion threshold, resulting in a lower proportion of VTE among suspected patients; the overdiagnosis and overtreatment of VTE, especially regarding calf deep-vein thrombosis (DVT) and subsegmental pulmonary embolism (SSPE).
疑似静脉血栓栓塞症（VTE）患者管理方面的最新进展既提高了诊断准确性，又使管理算法更安全、更易于使用且标准化程度更高。这些诊断算法主要基于临床预检概率评估、D-二聚体检测和成像检查，疑似深静脉血栓形成（DVT）时主要以加压超声（CUS）为代表，肺栓塞时则以计算机断层扫描肺动脉造影（CTPA）或肺通气灌注扫描为代表。这些诊断算法能为大多数疑似VTE患者提供安全且经济高效的诊断。在本综述中，我们关注特殊患者群体（如老年患者、孕妇或既往有VTE的患者）中VTE诊断的挑战。一些新出现的挑战可能需要对当前诊断策略进行调整，比如临床怀疑阈值降低，导致疑似患者中VTE的比例降低；VTE的过度诊断和过度治疗，尤其是关于小腿深静脉血栓形成（DVT）和亚段肺栓塞（SSPE）。
