Yadam Suman, Popuri Anand, Hattab Yousef, Cheema Tariq
Division of Pulmonary Critical Care Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania.
Crit Care Nurs Q. 2017 Jul/Sep;40(3):301-305. doi: 10.1097/CNQ.0000000000000168.
Numerous controversies exist in the diagnosis of venous thromboembolism despite all the guidelines that are currently available. Screening of malignancy in venous thromboembolism has been a debated issue, as it has not been shown to change mortality. Calf vein thrombosis is also a controversial topic, but evidence points to risk stratifying those patients. Overdiagnosis, most notably from the finding of subsegmental pulmonary embolism, ultimately requires evaluating the risk and benefit for each patient. In addition, treatment of upper extremity deep vein thrombosis is a challenging scenario that is quite common in clinical practice. Finally, postthrombotic syndrome may be reduced by graduated compression stockings, but their use has not been validated for preventive use at this time and is still being discussed.
尽管目前已有各种指南，但静脉血栓栓塞症的诊断仍存在诸多争议。静脉血栓栓塞症患者的恶性肿瘤筛查一直是个有争议的问题，因为尚未证明其能改变死亡率。小腿静脉血栓形成也是一个有争议的话题，但有证据表明应对这些患者进行风险分层。过度诊断，尤其是因发现亚段肺栓塞而导致的过度诊断，最终需要评估每位患者的风险和获益。此外，上肢深静脉血栓形成的治疗是临床实践中常见的具有挑战性的情况。最后，分级压力袜可能会减轻血栓后综合征，但目前其预防性使用尚未得到验证，仍在讨论中。
