20xx年醫(yī)學(xué)專題—deep-vein-thrombosis深靜脈血栓(已改無錯字)
2024-10-31 17 本頁面
【正文】 ctionated Heparin Weightbased dosing of UFH (80 U/kg bolus followed by 18 U/kg/hr IV infusion) has been shown to achieve a therapeutic activated partial thromboplastin time (aPTT) more rapidly than fixeddose regimens.,Deep vein thrombosis,第三十頁，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. Enoxaparin, the most commonly used agent in the US, is given either as a oncedaily injection (1.5 mg/kg/day) or twice daily (1 mg/kg every 12 hr).,Deep vein thrombosis,第三十一頁，共四十六頁。,Treatment,Medical Management: Anticoagulation Factor Xa Inhibitors Fondaparinux is an indirect factor Xa inhibitor that can be used as VTE prophylaxis in medical patients, those undergoing orthopedic procedures (total hip and knee arthroplasty), and those undergoing abdominal surgery.,Deep vein thrombosis,第三十二頁，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 New Oral Anticoagulants Dabigatran：direct thrombin inhibitor Rivaroxaban：factor Xa inhibitor,Deep vein thrombosis,第三十四頁，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: Surgical/Mechanical intervention Pulmonary Embolectomy According to ACCP guidelines, pulmonary embolectomy for the initial treatment of PE is reserved for patients with massive PE (documented angiographically if possible), shock despite heparin and resuscitation efforts, and failure of thrombolytic therapy or a contraindication to its,Deep vein thrombosis,第三十六頁，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 trea
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