Oxford Haemophilia and Thrombosis Centre, Oxford University Hospitals, Churchill Hospital, Old Road, Headington, Oxford OX3 7LJ, United Kingdom.
Department of Thrombosis and Hemostasis, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
Blood Rev. 2016 Jan;30(1):27-33. doi: 10.1016/j.blre.2015.07.003. Epub 2015 Jul 17.
Venous thromboembolism is commonly encountered both in the community and the in-patient setting. Despite major advances in diagnosis and treatment, there remain challenges in several clinical areas as a result of insufficient evidence to guide practice. This review covers six controversial topics, summarizes the best available evidence, and presents recommendations for practice. The clinical relevance of calf vein thrombosis and sub-segmental pulmonary embolism are often questioned; this has implications for both their diagnosis and management. The role of thrombolysis for the treatment of deep vein thrombosis (DVT) is discussed in consideration of the potential benefits and risks. Residual vein obstruction has been proposed as a predictor of recurrent thrombosis; we consider its relevance when determining the duration of anticoagulant treatment. The post-thrombotic syndrome (PTS) can be a disabling and costly consequence of DVT with limited options for prevention and treatment. We review the available evidence related to compression stockings for PTS prevention. Finally, the relationship between cancer and VTE is well recognized and this review considers the value of screening for occult cancer in patients with unprovoked VTE.
静脉血栓栓塞症在社区和住院环境中都很常见。尽管在诊断和治疗方面取得了重大进展，但由于缺乏指导实践的充分证据，在几个临床领域仍存在挑战。本综述涵盖了六个有争议的主题，总结了现有最佳证据，并提出了实践建议。小腿静脉血栓和亚段肺栓塞的临床相关性经常受到质疑；这对它们的诊断和治疗都有影响。鉴于溶栓治疗的潜在益处和风险，我们讨论了溶栓治疗深静脉血栓形成（DVT）的作用。残留静脉阻塞被认为是复发性血栓形成的预测因素；当确定抗凝治疗的持续时间时，我们会考虑其相关性。血栓后综合征（PTS）是 DVT 的一种致残且昂贵的后果，预防和治疗的选择有限。我们回顾了与 PTS 预防用压缩袜相关的现有证据。最后，癌症与 VTE 的关系已得到充分认识，本综述考虑了在无诱因 VTE 患者中筛查隐匿性癌症的价值。
