Unanswered questions in venous thromboembolism
Unanswered questions in venous thromboembolism
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DOI：
10.1016/s0049-3848(09)70135-5
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发表时间：
2009-01-01
影响因子：
7.5
通讯作者：
Weitz, Jeffrey I.
中科院分区：
文献类型：
--
作者：
Weitz, Jeffrey I.
我们在静脉血栓栓塞（VTE）的诊断、治疗和预防方面取得了很大进展。然而，尽管取得了这些进展，问题仍然存在。也许最重要的未满足需求是制定和实施战略，以增加对血栓预防指南的接受。静脉血栓栓塞在很大程度上可以通过适当的预防措施加以预防。新的口服抗凝剂有可能进一步简化静脉血栓栓塞的预防和治疗。虽然肝素、低分子量肝素或氟达肝素常用于住院内科或外科患者的血栓预防，但这些药物并不理想。供院外使用。现在有很好的证据表明，接受重大骨科手术的患者需要延长血栓预防。医疗病人也可能受益于延长预防。新的口服抗凝剂将比现有的药物更方便，并将帮助医生和患者坚持最佳的预防策略。静脉血栓栓塞治疗也可以简化与新的口服抗凝剂。由于起效迅速，这些药物在初始治疗时可能不需要静脉注射抗凝剂。此外，与维生素K拮抗剂不同，这些新药物可以在不需要凝血监测的情况下以固定剂量给药，因此具有简化静脉血栓栓塞治疗的潜力。2009爱思唯尔有限公司版权所有。
We have made great strides in the diagnosis, treatment and prevention of venous thromboembolism (VTE). Despite these advances, however, questions remain. Perhaps the most important unmet need is the development and implementation of strategies to increase the uptake of guidelines for thromboprophylaxis. VTE is largely preventable with appropriate prophylaxis. New oral anticoagulants have the potential to further streamline VTE prevention and treatment. Although heparin, low molecular weight heparins or fondaparinux are frequently used for thromboprophylaxis in hospitalized medical or surgical patients, these agents are not ideal. for out-of-hospitat use. There is now good evidence that patients undergoing major orthopaedic surgery require extended thromboprophytaxis. Medical patients may also benefit from extended prophylaxis. The new oral anticoagulants wilt be more convenient than existing agents for this purpose and will help physicians and patients to adhere to optimal preventive strategies. VTE treatment also may be simplified with the new oral anticoagulants. With a rapid onset of action, these drugs may obviate the need for a parenteral, anticoagulant for initial therapy. In addition, the new agents have the potential to streamline extended VTE therapy because, unlike vitamin K antagonists, they can be given in fixed doses without the need for coagulation monitoring. (C) 2009 Elsevier Ltd. All rights reserved.