Department of Internal Medicine, Northwell Health at Staten Island University Hospital, Staten Island, New York.
Center for Health Innovations and Outcomes Research, The Feinstein Institutes for Medical Research and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York.
Semin Respir Crit Care Med. 2021 Apr;42(2):308-315. doi: 10.1055/s-0041-1723018. Epub 2021 Feb 6.
Venous thromboembolism (VTE) is the leading preventable cause of death in hospitalized patients and data consistently show that acutely ill medical patients remain at increased risk for VTE-related morbidity and mortality in the post-hospital discharge period. Prescribing extended thromboprophylaxis for up to 45 days following an acute hospitalization in key patient subgroups that include more than one-quarter of hospitalized medically-ill patients represents a paradigm shift in the way hospital-based physicians think about VTE prevention. Advances in the field of primary thromboprophylaxis in acutely-ill medical patients using validated VTE and bleeding risk assessment models have established key patient subgroups at high risk of VTE and low risk of bleeding that may benefit from both in-hospital and extended thromboprophylaxis. The direct oral anticoagulants betrixaban and rivaroxaban are now U.S. Food and Drug Administration-approved for in-hospital and extended thromboprophylaxis in medically ill patients and provide net clinical benefit in these key subgroups. Coronavirus disease-2019 may predispose patients to VTE due to excessive inflammation, platelet activation, endothelial dysfunction, and hemostasis. The optimum preventive strategy for these patients requires further investigation. This article aims to review the latest concepts in predicting and preventing VTE and discuss the new era of extended thromboprophylaxis in hospitalized medically ill patients.
静脉血栓栓塞症（VTE）是住院患者中可预防的主要死亡原因，数据一致表明，在住院后出院期间，急性重病患者仍然存在与 VTE 相关发病率和死亡率增加的风险。在包括超过四分之一住院内科患者的关键患者亚组中，为急性住院后的 45 天内开具延长抗血栓治疗，代表了医院医生在思考 VTE 预防方面的范式转变。在使用经过验证的 VTE 和出血风险评估模型的急性内科患者中，初级抗血栓预防领域的进展已经确定了具有高 VTE 风险和低出血风险的关键患者亚组，他们可能受益于住院期间和延长抗血栓治疗。直接口服抗凝剂贝曲沙班和利伐沙班现已获得美国食品和药物管理局批准，可用于内科住院患者的住院期间和延长抗血栓治疗，并为这些关键亚组提供净临床获益。由于过度炎症、血小板激活、内皮功能障碍和止血，COVID-19 可能使患者易发生 VTE。这些患者的最佳预防策略需要进一步研究。本文旨在回顾预测和预防 VTE 的最新概念，并讨论住院内科患者中延长抗血栓治疗的新时代。
