Pesavento Raffaele, Prandoni Paolo
Department of Cardiothoracic and Vascular Sciences, Vascular Medicine Unit, University of Padua, Via Giustiniani 2, 35128 Padua, Italy.
Expert Rev Cardiovasc Ther. 2015 Feb;13(2):193-207. doi: 10.1586/14779072.2015.1000306. Epub 2015 Jan 12.
Post-thrombotic syndrome (PTS) and chronic thromboembolic pulmonary hypertension (CTEPH) are late complications of venous thromboembolism. The purpose of this review is to present and discuss recently published studies that have improved our knowledge of PTS and CTEPH. The current understanding of the pathophysiology of PTS and CTEPH is discussed as well as the importance of chronic residual venous thrombosis, some polymorphisms of plasminogen activator inhibitor-1, and the current concept of misguided thrombus resolution. The surprising finding that elastic compression stockings may not be effective in preventing PTS and the novel medical treatment in CTEPH are discussed in detail. Novel direct oral anticoagulants show potential for prevention of PTS. No firm conclusions can be drawn on the efficacy of elastic stockings. Novel treatments of CTEPH for inoperable patients and those with persistent pulmonary hypertension after surgery have become available and further research on wider indication for their use is urgently needed.
血栓形成后综合征（PTS）和慢性血栓栓塞性肺动脉高压（CTEPH）是静脉血栓栓塞症的晚期并发症。本综述的目的是介绍和讨论最近发表的研究，这些研究增进了我们对PTS和CTEPH的认识。文中讨论了目前对PTS和CTEPH病理生理学的理解，以及慢性残余静脉血栓形成、纤溶酶原激活物抑制剂-1的某些多态性的重要性，以及误导性血栓溶解的当前概念。详细讨论了弹力袜可能无法有效预防PTS这一惊人发现以及CTEPH的新型药物治疗。新型直接口服抗凝剂显示出预防PTS的潜力。关于弹力袜的疗效尚无确凿结论。针对无法手术的患者以及术后持续性肺动脉高压患者的CTEPH新型治疗方法已经出现，迫切需要对其更广泛应用指征进行进一步研究。
