20xx年醫(yī)學(xué)專題—deep-vein-thrombosis深靜脈血栓(完整版)
【正文】 rom the site of origin to plug another vessel.,Deep vein thrombosis,第十頁，共四十六頁。,Diagnosis,Physical Exam: symptoms Half of those with the condition HAVE NO SYMPTOMS. Signs and symptoms alone are not sufficiently sensitive or specific to make a diagnosis, but when considered in conjunction with known risk factors can help determine the likelihood of DVT.,Deep vein thrombosis,第十七頁，共四十六頁。,Diagnosis,Contrast Venography: The gold standard methods to reveal whether the venous supply has been obstructed.,Deep vein thrombosis,(a) direct manual contrast injection into the guiding catheter (direct venography technique, DVT) and (b) occlusion of coronary sinus by a SwanGanz catheter .,第二十五頁，共四十六頁。,Treatment,Medical Management: Anticoagulation Warfarin Warfarin remains the mainstay of therapy for longterm treatment of VTE. It may be initiated once anticoagulation with UFH, LWMH, or fondaparinux has been started (and which should be continued as overlap treatment for a minimum of 5 days and until the international normalized ratio [INR] is at least 2.0 for 24 hours).,Deep vein thrombosis,第三十三頁，共四十六頁。,Prevention,Approximately twothirds of all DVT events result from hospitalization, yet only one third of all hospitalized patients at risk receive adequate prophylaxis. PE is the most common preventable cause of hospital death in the US. Without prophylaxis, the incidence of hospitalacquired DVT is 10% to 20% among medical patients and higher (15% to 40%) among surgical patients.,Deep vein thrombosis,第四十一頁，共四十六頁。,。,Prevention,Computed tomographic pulmonary angiography has replaced the ventilation perfusion scan for diagnosing PE. Risk stratification is the key to management of patients with VTE. Indefinite anticoagulation should be considered for patients with an idiopathic or unprovoked VTE. Appropriate prophylaxis remains underused.,Deep vein thrombosis,第四十三頁，共四十六頁。,Treatment,Medical Management: Anticoagulation Thrombolytic Therapy Thrombolytic therapy for DVT may be beneficial in selected patients, and although it can be administered systemically. Thrombolytic therapy for acute PE remains controversial because there has been no clearly established shortterm mortality benefit.,Deep vein thrombosis,第三十五頁，共四十六頁。,Diagnosis,The AAFP and the ACP have published a clinical practice guideline that summarizes current approaches for the diagnosis of DVT Clinical prediction rules should be used to estimate the pretest probability of DVT . In selected patients with a low pretest probability of
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