Prevention of Recurrent Idiopathic Venous Thromboembolism
Prevention of Recurrent Idiopathic Venous Thromboembolism
复制标题
预防复发性特发性静脉血栓栓塞
DOI：
10.1161/01.cir.0000150641.65000.f2
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发表时间：
2004
期刊：
影响因子：
37.8
通讯作者：
S. Goldhaber
中科院分区：
文献类型：
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作者：
S. Goldhaber
特发性静脉血栓栓塞症（VTE），与手术或创伤无关，是一种慢性疾病，需要实施策略以防止终生复发。临床试验表明，一旦停止治疗，特发性VTE患者延长抗凝治疗≤1年的相关获益不会长期维持。对照试验已经确定了不确定持续时间抗凝的疗效，即使使用的治疗是一种新的药物，而不是香豆素衍生物。PREVENT、ELATE和THRIVE III试验证明，在特发性VTE患者（包括孤立性小腿深静脉血栓形成患者）中采用长期抗凝治疗策略是安全有效的。这种成功的策略似乎对所有亚组都有益，无论是否存在已确定的血栓形成状态。这些包括年轻和老年患者的两种性别，那些与因子V莱顿或凝血酶原基因突变，和那些与首次或复发性静脉血栓栓塞。因此，除非有禁忌症，特发性VTE的默认策略应是普遍抗凝。在人群基础上实施这种经过验证的方法将能够以最小的个体化治疗预防VTE复发。由于终身治疗可以精确的心理和医疗成本的病人以及医疗保健提供者，未来的研究应该针对那些最容易复发的风险分层。目前正在评估的研究途径包括测量d-二聚体水平，超声检查残余静脉血栓形成，以及应用风险列线图。
Idiopathic venous thromboembolism (VTE), unassociated with surgery or trauma, is a chronic illness that warrants the implementation of strategies to prevent recurrence over a lifetime. Clinical trials show that the benefit associated with extended anticoagulation therapy ≤1 year in patients with idiopathic VTE is not maintained over the long term once treatment is discontinued. Controlled trials have established the efficacy of indefinite-duration anticoagulation, even if the therapy used is a novel agent that is not a coumarin derivative. The PREVENT, ELATE, and THRIVE III trials demonstrate that a strategy of long-term anticoagulation in patients with idiopathic VTE, including those with isolated calf deep vein thrombosis, is safe and effective. This successful strategy appears beneficial across all subgroups, regardless of the presence of an identified thrombophilic state. These include both young and old patients of both sexes, those with factor V Leiden or the prothrombin gene mutation, and those with first-time or recurrent VTE. Thus, the default strategy for idiopathic VTE should be universal anticoagulation unless contraindicated. Implementing this proven approach on a population basis would enable prevention of VTE recurrence with minimal individualization of treatment. Because lifelong therapy can exact a psychological and medical cost on the patient as well as the health care provider, future research should be directed to risk stratification of those most susceptible to recurrence. Avenues of investigation currently being evaluated include measurement of d-dimer levels, examination of residual venous thrombosis on ultrasound, and application of risk nomograms.
影响因子：
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作者：
Heit, JA;Mohr, DN;Melton, LJ
通讯作者：
Melton, LJ
影响因子：
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作者：
Heit, JA;Silverstein, MD;Melton, LJ
通讯作者：
Melton, LJ