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急性静脉血栓栓塞症的重症监护管理:整合药物治疗、血栓切除术和临时机械支持

Critical Care Management of Acute Venous Thromboembolism: Integrating Pharmacotherapy, Thrombectomy, and Temporary Mechanical Support.

作者信息

Okumus Nazli, Park Ashley, Yuridistky Eugene, Horowitz James M, Solomon Michael A

机构信息

Department of Cardiovascular Medicine, Allegheny Health Network Pittsburgh, PA.

Critical Care Medicine Department, National Institutes of Health Clinical Center Bethesda, MD.

出版信息

US Cardiol. 2024 Nov 27;18:e21. doi: 10.15420/usc.2024.11. eCollection 2024.

Abstract

Venous thromboembolism (VTE), which includes pulmonary embolism and deep vein thrombosis, carries significant morbidity and mortality risks, and is conventionally managed with anticoagulation. In recent years, notable progress has been made in the therapeutic options available for the acute treatment of VTE. The heterogeneity within pulmonary embolism, spanning a wide spectrum of risks, underscores the critical need for precise risk stratification, particularly in identifying individuals prone to right heart failure and increased mortality. This review navigates the transformative developments in VTE approaches, focusing on the diagnosis and management of acute VTE in the critical care setting. It encompasses developing critical care approaches to intermediate- and high-risk pulmonary embolism, the treatment of right heart failure, and the integration of mechanical circulatory support, providing comprehensive insights into risk stratification, emerging interventions, and evolving treatment strategies. It is important to note that some of the novel therapies are still under clinical trials and, despite promising reports, are not yet considered standard of care.

摘要

静脉血栓栓塞症(VTE)包括肺栓塞和深静脉血栓形成,具有显著的发病和死亡风险,传统上采用抗凝治疗。近年来,VTE急性治疗的可用治疗选择取得了显著进展。肺栓塞的异质性涵盖了广泛的风险,突出了精确风险分层的迫切需求,特别是在识别易患右心衰竭和死亡率增加的个体方面。本综述探讨了VTE治疗方法的变革性发展,重点关注重症监护环境中急性VTE的诊断和管理。它包括制定针对中高危肺栓塞的重症监护方法、右心衰竭的治疗以及机械循环支持的整合,提供了关于风险分层、新兴干预措施和不断演变的治疗策略的全面见解。需要注意的是,一些新疗法仍在临床试验中,尽管有令人鼓舞的报告,但尚未被视为标准治疗方法。

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