Witt Daniel M, Clark Nathan P, Kaatz Scott, Schnurr Terri, Ansell Jack E
University of Utah College of Pharmacy, 30 South 2000 East, Salt Lake City, UT, 84112, USA.
Clinical Pharmacy Anticoagulation and Anemia Services, Kaiser Permanente Colorado, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Services, Aurora, CO, USA.
J Thromb Thrombolysis. 2016 Jan;41(1):187-205. doi: 10.1007/s11239-015-1319-y.
Venous thromboembolism (VTE) is a serious and often fatal medical condition with an increasing incidence. The treatment of VTE is undergoing tremendous changes with the introduction of the new direct oral anticoagulants and clinicians need to understand new treatment paradigms. This article, initiated by the Anticoagulation Forum, provides clinical guidance based on existing guidelines and consensus expert opinion where guidelines are lacking. Well-managed warfarin therapy remains an important anticoagulant option and it is hoped that anticoagulation providers will find the guidance contained in this article increases their ability to achieve optimal outcomes for their patients with VTE Pivotal practical questions pertaining to this topic were developed by consensus of the authors and were derived from evidence-based consensus statements whenever possible. The medical literature was reviewed and summarized using guidance statements that reflect the consensus opinion(s) of all authors and the endorsement of the Anticoagulation Forum's Board of Directors. In an effort to provide practical and implementable information about VTE and its treatment, guidance statements pertaining to choosing good candidates for warfarin therapy, warfarin initiation, optimizing warfarin control, invasive procedure management, excessive anticoagulation, subtherapeutic anticoagulation, drug interactions, switching between anticoagulants, and care transitions are provided.
静脉血栓栓塞症（VTE）是一种严重且往往致命的疾病，其发病率呈上升趋势。随着新型直接口服抗凝剂的引入，VTE的治疗正在经历巨大变革，临床医生需要了解新的治疗模式。本文由抗凝论坛发起，基于现有指南以及在缺乏指南时的专家共识意见提供临床指导。管理良好的华法林治疗仍然是一种重要的抗凝选择，希望抗凝治疗提供者能发现本文中的指导内容可增强他们为VTE患者实现最佳治疗效果的能力。与该主题相关的关键实际问题由作者们通过共识确定，并且尽可能源自循证共识声明。医学文献通过反映所有作者共识意见以及抗凝论坛董事会认可的指导声明进行了综述和总结。为了提供关于VTE及其治疗的实用且可实施的信息，本文提供了有关选择华法林治疗的合适人选、启动华法林治疗、优化华法林控制、侵入性操作管理、抗凝过度、抗凝不足、药物相互作用、抗凝剂之间的转换以及护理过渡等方面的指导声明。
