Pauschert R, Diehm C, Stammler F
Fachklinik f. Konservative Orthopädie u. Physikal. Medizin, Bad Wimpfen.
Z Orthop Ihre Grenzgeb. 1998 Sep-Oct;136(5):471-9. doi: 10.1055/s-2008-1053687.
The necessity of effective prevention of DVT is generally accepted. However, attitudes and beliefs concerning prophylaxis vary greatly in terms of the risk groups receiving prophylaxis and the prophylactic methodology. This paper reviews current research on the subject and seeks to provide recommendations.
Known clinical risk factors allow the classification of patients according to high, medium and low risk of developing thromboembolism. Basic forms of prophylaxis are physiotherapy and early mobilisation. However, there are no data on the safety and efficacy of these methods. Mechanical devices used include external intermittent pneumatic compression and graduated compression stockings. Used in isolation, these methods reduce the incidence of deep vein thrombosis in low and moderate risk patients by one half or one third. There is no distinction between mechanical and pharmacological methods in terms of safety and efficacy. Furthermore, secondary effects are extremely rare. Moderate and high risk category patients should receive combined modes of mechanical and pharmacological treatment. A direct comparison of safety in moderate risk patients fixed doses of standard heparin vs. low molecular weight heparin revealed no significant differences. In the case of high risk patients, adjusted dose heparin administered subcutaneously or fixed dose low molecular heparin is recommended. A severe secondary effect of heparin-prophylaxis is heparin-induced thrombocytopenie. The optimum duration of pharmacological prophylaxis is not yet clear.
The methods and duration of prophylaxis remain subject to an individual medical assessment of the clinically significant benefits in relation to the risk secondary effects of the treatment. On major questions there are significant variations in the specialist literature. This means that standards cannot be formulated, although recommendations can be given.
有效预防深静脉血栓形成（DVT）的必要性已得到普遍认可。然而，在接受预防的风险群体以及预防方法方面，有关预防的态度和观念差异很大。本文回顾了该主题的当前研究并试图提供建议。
已知的临床风险因素可根据发生血栓栓塞的高、中、低风险对患者进行分类。预防的基本形式是物理治疗和早期活动。然而，尚无关于这些方法安全性和有效性的数据。使用的机械装置包括外部间歇性气动压迫和分级压迫弹力袜。单独使用这些方法可使低风险和中度风险患者的深静脉血栓形成发生率降低一半或三分之一。在安全性和有效性方面，机械方法和药物方法并无区别。此外，副作用极为罕见。中度和高风险类别患者应接受机械和药物联合治疗模式。对中度风险患者固定剂量标准肝素与低分子量肝素的安全性进行直接比较，结果显示无显著差异。对于高风险患者，建议皮下注射调整剂量肝素或固定剂量低分子肝素。肝素预防的一种严重副作用是肝素诱导的血小板减少症。药物预防的最佳持续时间尚不清楚。
预防方法和持续时间仍需根据临床显著益处与治疗风险副作用的个体医学评估来确定。在一些主要问题上，专业文献存在显著差异。这意味着虽然可以给出建议，但无法制定标准。
