Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan.
J Cardiol. 2022 Jan;79(1):79-89. doi: 10.1016/j.jjcc.2021.08.026. Epub 2021 Sep 10.
Clinicians have been more and more often encountering patients with venous thromboembolism (VTE), including pulmonary embolism and deep vein thrombosis, leading to the increased importance of VTE in daily clinical practice. VTE is becoming a common issue in Asian countries including Japan. The management strategies of VTE have changed dramatically in the past decade including the introduction of direct oral anticoagulants (DOACs). In addition, there have been several landmark clinical trials assessing acute treatment strategies including thrombolysis and inferior vena cava (IVC) filter. The current VTE guidelines do not recommend the routine use of thrombolysis or IVC filters based on recent evidence; Nevertheless, the prevalence of thrombolysis and IVC filter use in Japan was strikingly high. The novel profiles of DOACs with rapid onset of action and potential benefit of a lower risk for bleeding compared with vitamin K antagonist could make home treatment feasible and is safer even with extended anticoagulation therapy. One of the most clinically relevant issues for VTE treatment is optimal duration of anticoagulation for the secondary prevention of VTE. Considering recent evidence, optimal duration of anticoagulation should be determined based on the risk for recurrence as well as the risk for bleeding in an individual patient. Despite the recent advances for VTE management, there are still a number of uncertain issues that challenge clinicians in daily clinical practice, such as cancer-associated VTE and minor VTE including subsegmental pulmonary embolism and distal deep vein thrombosis, warranting future research. Several clinical trials are now ongoing for these issues, globally as well as in Japan. The current review is aimed to overview the recent advances in VTE management, describe the current status including some domestic issues in Japan, and discuss the future perspective of VTE.
临床医生越来越多地遇到静脉血栓栓塞症（VTE）患者，包括肺栓塞和深静脉血栓形成，这导致 VTE 在日常临床实践中的重要性日益增加。VTE 在包括日本在内的亚洲国家已成为一个常见问题。在过去十年中，VTE 的管理策略发生了巨大变化，包括直接口服抗凝剂（DOAC）的引入。此外，还有几项评估急性治疗策略的里程碑式临床试验，包括溶栓和下腔静脉（IVC）滤器。目前的 VTE 指南基于最近的证据不建议常规使用溶栓或 IVC 滤器；然而，日本溶栓和 IVC 滤器的使用非常普遍。DOAC 的新型特征具有快速作用和潜在的出血风险较低的优势，与维生素 K 拮抗剂相比，可能使家庭治疗成为可能，即使延长抗凝治疗也更安全。VTE 治疗中最具临床相关性的问题之一是抗凝治疗的最佳持续时间，以预防 VTE 的二次复发。考虑到最近的证据，抗凝治疗的最佳持续时间应根据个体患者的复发风险和出血风险来确定。尽管 VTE 管理取得了最近的进展，但在日常临床实践中仍有许多不确定的问题挑战着临床医生，例如癌症相关的 VTE 和较小的 VTE，包括亚段肺栓塞和远端深静脉血栓形成，需要进一步研究。目前，全球和日本都有多项针对这些问题的临床试验正在进行。本文旨在综述 VTE 管理的最新进展，描述当前的现状，包括日本的一些国内问题，并讨论 VTE 的未来前景。
