20xx年醫(yī)學(xué)專題—deep-vein-thrombosis深靜脈血栓(參考版)
2024-10-31 17:01本頁面
【正文】 ,。ir243。,Thank You!,Xiang Yu Cheng,第四十五頁，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。,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。,Treatment,Although the risk of recurrence decreases with longer durations of anticoagulation, clinicians must weigh the risk of bleeding against the risk of new thrombosis.,Deep vein thrombosis,第三十九頁，共四十六頁。,Treatment,Medical Management: Surgical/Mechanical intervention Vena Caval Interruption Current guidelines recommend against the routine use of inferior vena cava (IVC) filters for the treatment of VTE. Indications for the placement of IVC filters include a contraindication to anticoagulation, complications of anticoagulation, recurrent thromboembolism despite adequate anticoagulant therapy, and patients undergoing pulmonary embolectomy.,Deep vein thrombosis,第三十七頁，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。,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。,Treatment,Medical Management: Anticoagulation LowMolecularWeightHeparin LMWH is administered as a weightbased subcutaneous injection. In the current ACCP guidelines, LMWH is recommended over UFH for the initial treatment of DVT or PE. Enoxa
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