Lowe G D
University Department of Medicine, Glasgow Royal Infirmary, UK.
Baillieres Clin Obstet Gynaecol. 1997 Sep;11(3):511-21. doi: 10.1016/s0950-3552(97)80025-9.
Clinically suspected deep vein thrombosis (DVT) or pulmonary thromboembolism (PE) should be initially treated with heparin, and an objective diagnosis obtained. In pregnancy, heparin is usually continued until delivery, following which warfarin is substituted. In the absence of pregnancy, warfarin is substituted and usually continued for 3 months after a first thrombo-embolic event. Low molecular weight heparins are increasingly preferred to unfractionated heparin in non-pregnant patients with acute DVT, because of efficacy when given by daily subcutaneous injection without routine monitoring of coagulation assays, greater efficacy, and lower risks of major bleeding and of mortality. Unfractionated heparin requires monitoring by the APTT (target ratio 1.5-2.5), and warfarin requires monitoring by the International Normalized Ratio (INR) of the prothrombin time (target ratio 2.0-3.0). Graduated elastic compression stockings reduce post-thrombotic leg symptoms after DVT. Secondary prevention is important in future high risk situations.
临床怀疑的深静脉血栓形成（DVT）或肺血栓栓塞症（PE）最初应使用肝素治疗，并进行客观诊断。在妊娠期间，肝素通常持续使用至分娩，之后改用华法林。非妊娠情况下，改用华法林，首次血栓栓塞事件后通常持续使用3个月。在急性DVT的非妊娠患者中，低分子量肝素越来越比普通肝素更受青睐，因为每日皮下注射给药时无需常规监测凝血测定，疗效更好，大出血和死亡风险更低。普通肝素需要通过活化部分凝血活酶时间（APTT，目标比值1.5 - 2.5）进行监测，华法林需要通过凝血酶原时间的国际标准化比值（INR，目标比值2.0 - 3.0）进行监测。分级弹力袜可减轻DVT后血栓形成后腿部症状。二级预防在未来的高风险情况下很重要。
