Antithrombotic therapy for venous thromboembolic disease
Antithrombotic therapy for venous thromboembolic disease
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DOI：
10.1378/chest.126.3_suppl.401s
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发表时间：
2004-09-01
期刊：
影响因子：
9.6
通讯作者：
Raskob, GE
中科院分区：
文献类型：
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作者：
Büller, HR;Agnelli, G;Raskob, GE
关于静脉血栓栓塞性疾病的抗血栓治疗的这一章是第七届ACCP抗血栓和溶栓治疗会议的一部分：循证指南。I级建议是强有力的，表明收益是否超过了风险、负担和成本。等级2表明，个体患者的价值观可能会导致不同的选择(有关分级的完整理解，请参阅Guyatt等人，胸部2004；126：179S-187S)。本章的主要建议如下：对于客观确诊的深静脉血栓形成(DVT)患者，我们建议使用皮下(SC)低分子肝素(LMWH)或静脉普通肝素(UFH)进行短期治疗[均为1A级]。对于临床高度怀疑DVT的患者，我们建议在等待诊断测试结果(1C+级)的同时使用抗凝剂进行治疗。对于急性DVT，我们建议最初使用LMWH或UFH治疗至少5天(1C级)，在第一天开始使用维生素K拮抗剂(VKA)与LMWH或UFH一起治疗，当国际标准化比率(INR)稳定和>；2.0(1A级)时停用肝素。对于腿部急性DVT的治疗时间和强度，建议如下：对于首次出现继发于短暂(可逆)危险因素的DVT的患者，我们建议使用VKA进行3个月的长期治疗，而不是短期治疗(1A级)。对于首发特发性深静脉血栓的患者，我们建议至少使用VKA治疗6至12个月(1A级)。我们建议调整VKA的剂量，以维持所有疗程(1A级)的目标INR为2.5(INR范围为2.0至3.0)。我们建议不要进行高强度VKA治疗(INR范围从3.1到4.0)[1A级]，也不要进行低强度治疗(INR范围从1.5到1.9)，而INR范围是2.0到3.0(1A级)。为了预防血栓形成后综合征，我们建议使用弹性压缩袜子(1A级)。对于客观确诊为非大面积PE的患者，我们建议采用SC、LMWH或IV UFH急诊治疗(两者均为1A级)。对于大多数肺栓塞(PE)患者，我们建议临床医生不要使用全身溶栓治疗(1A级)。对于PE的治疗时间和强度，建议与DVT相似。
This chapter about antithrombotic therapy for venous thromboembolic disease is part of the seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy: Evidence Based Guidelines. Grade I recommendations are strong and indicate that the benefits do, or do not, outweigh risks, burden, and costs. Grade 2 suggests that individual patients' values may lead to different choices (for a full understanding of the grading see Guyatt et al, CHEST 2004; 126:179S-187S). Among the key recommendations in this chapter are the following: for patients with objectively confirmed deep vein thrombosis (DVT), we recommend short-term treatment with subcutaneous (SC) low molecular weight heparin (LMWH) or, alternatively, IV unfractionated heparin (UFH) [both Grade 1A]. For patients with a high clinical suspicion of DVT, we recommend treatment with anticoagulants while awaiting the outcome of diagnostic tests (Grade 1C+). In acute DVT, we recommend initial treatment with LMWH or UFH for at least 5 days (Grade 1C), initiation of vitamin K antagonist (VKA) together with LMWH or UFH on the first treatment day, and discontinuation of heparin when the international normalized ratio (INR) is stable and > 2.0 (Grade 1A). For the duration and intensity of treatment for acute DVT of the leg, the recommendations include the following: for patients with a first episode of DVT secondary to a transient (reversible) risk factor, we recommend long-term treatment with a VKA for 3 months over treatment for shorter periods (Grade 1A). For patients with a first episode of idiopathic DVT, we recommend treatment with a VKA for at least 6 to 12 months (Grade 1A). We recommend that the dose of VKA be adjusted to maintain a target INR of 2.5 (INR range, 2.0 to 3.0) for all treatment durations (Grade 1A). We recommend against high-intensity VKA therapy (INR range, 3.1 to 4.0) [Grade 1A] and against low-intensity therapy (INR range, 1.5 to 1.9) compared to INR range of 2.0 to 3.0 (Grade 1A). For the prevention of the postthrombotic syndrome, we recommend the use of an elastic compression stocking (Grade 1A). For patients with objectively confirmed nonmassive PE, we recommend acute treatment with SC LMWH or, alternatively, IV UFH both Grade 1A). For most patients with pulmonary embolism (PE), we recommend clinicians not use systemic thrombolytic therapy (Grade 1A). For the duration and intensity of treatment for PE, the recommendations are similar to those for DVT.