Shakeel Musfira, Thachil Jecko
Medical Student, University of Manchester, Manchester M13 9WL.
Consultant Haematologist, Department of Haematology, Manchester Royal Infirmary, Manchester.
Br J Hosp Med (Lond). 2017 Oct 2;78(10):552-557. doi: 10.12968/hmed.2017.78.10.552.
Venous thromboembolism most commonly affects older patients. Despite the high incidence in this population, challenges remain in terms of the understanding of its presentation, diagnosis and management. Old age is associated with multi-morbidities which may complicate the diagnosis of venous thromboembolism as signs or symptoms may be attributed to underlying medical conditions. The presence of certain comorbidities (such as congestive cardiac failure and chronic obstructive pulmonary disease) also increases the risk of venous thromboembolism, but could mimic the clinical features of pulmonary embolism. In addition, the physiological processes associated with ageing and factors such as immobility and malignancy, which are more common in older people, will further increase the thrombotic risk. Dilemmas also exist with treatment decisions because of the concomitant increased risk of bleeding, comorbidities, polypharmacy, frailty and the risk of falls.
静脉血栓栓塞最常影响老年患者。尽管该人群发病率很高，但在对其表现、诊断和管理的认识方面仍存在挑战。老年与多种疾病相关，这可能使静脉血栓栓塞的诊断复杂化，因为体征或症状可能归因于基础疾病。某些合并症（如充血性心力衰竭和慢性阻塞性肺疾病）的存在也会增加静脉血栓栓塞的风险，但可能会模仿肺栓塞的临床特征。此外，与衰老相关的生理过程以及老年人中更常见的诸如活动不便和恶性肿瘤等因素，将进一步增加血栓形成风险。由于出血风险增加、合并症、多种药物治疗、身体虚弱和跌倒风险等因素，治疗决策也存在困境。
