【正文】 Prevention ? Longterm plications include recurrent VTE, CTPH, and the PTS. ?The recurrence rate for idiopathic VTE approaches 30% after 10 years, the incidence of CTPH is 4% at 2 years, and the rate of PTS is 30% at 8 years. ? D dimer is an excellent test to exclude VTE. ? Duplex ultrasonography is the noninvasive test of choice for the diagnosis of DVT. Deep vein thrombosis 第四十二頁(yè)，共四十六頁(yè)。 Diagnosis ?Contrast Venography: The gold standard methods to reveal whether the venous supply has been obstructed. Unilateral above knee DVT in a patient with a recent right hemisphere cerebral infarction. A 19yearold man with MayThurner syndrome with swelling of the left lower extremity. Phlebography in a patient with deep venous thrombosis. Deep vein thrombosis 第二十六頁(yè)，共四十六頁(yè)。 Causes ? Independent Risk Factors for DVT Deep vein thrombosis 第十一頁(yè)，共四十六頁(yè)。 Deep vein thrombosis Xiang Yu Cheng 第一頁(yè)，共四十六頁(yè)。 Signs and symptoms ? Common signs and symptoms of DVT include： √ Pain … √ Swelling… √ Warmth… √ Redness or discoloration… √ Distention of surface veins… Deep vein thrombosis 第十二頁(yè)，共四十六頁(yè)。 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 DVT or PE, a negative highsensitivity Ddimer test indicates a low likelihood of VTE. ? Ultrasound is remended for patients with intermediate to high pretest probability of DVT in the legs. ? Patients with intermediate or high pretest probability of PE require additional diagnostic imaging studies. Deep vein thrombosis 第二十七頁(yè)，共四十六頁(yè)。 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(yè)，共四十六頁(yè)。 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 mon 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(yè)，共四十六頁(yè)。 Diag