Enrico J F
Ther Umsch. 1989 Oct;46(10):732-8.
Deep venous thrombosis and pulmonary embolism are frequently diagnosed in patients encountered in a primary-care practice. Poor prognosis is related to acute sudden death and to recurrent thromboembolic disease. Anticoagulant therapy with heparin followed by coumarin derivatives is highly effective in preventing such recurrences, but the intensity of anticoagulation must be strictly monitored. Treatment with heparin, sufficient to prolong the activated partial prothrombin time to 1.5 to 2.0 times the control, should be continued for five to ten days, and oral anticoagulation should be overlapped with heparin for four to five days. The recommended therapeutic range for the prothrombin time during coumarin therapy is an INR of 2.0 to 3.0. The duration of anticoagulant treatment must be tailored to the individual patient. Patients with slowly resolving risk factors must be treated for at least three months after an acute deep vein thrombosis and for six months after a pulmonary embolism. Patients with tumors, antithrombin III, protein C or S deficiency should be treated indefinitely.
在基层医疗实践中接诊的患者中，深静脉血栓形成和肺栓塞经常被诊断出来。预后不良与急性猝死和复发性血栓栓塞性疾病有关。先用肝素抗凝治疗，随后使用香豆素衍生物，在预防此类复发方面非常有效，但抗凝强度必须严格监测。肝素治疗应持续五至十天，使活化部分凝血活酶时间延长至对照值的1.5至2.0倍，口服抗凝药应与肝素重叠使用四至五天。香豆素治疗期间凝血酶原时间的推荐治疗范围是国际标准化比值（INR）为2.0至3.0。抗凝治疗的持续时间必须根据个体患者进行调整。具有缓慢缓解风险因素的患者，急性深静脉血栓形成后必须治疗至少三个月，肺栓塞后必须治疗六个月。患有肿瘤、抗凝血酶III、蛋白C或S缺乏症的患者应无限期治疗。
