Venous thromboembolic risk and its prevention in hospitalized medical patients
Venous thromboembolic risk and its prevention in hospitalized medical patients
复制标题
DOI：
10.1055/s-2002-36702
复制
发表时间：
2002-12-01
影响因子：
5.7
通讯作者：
Haas, SK
中科院分区：
文献类型：
--
作者：
Haas, SK
在内科患者中，静脉血栓栓塞（VTE）的风险被大大低估，预防措施的使用远远少于外科患者，这反映了支持非外科环境中抗血栓治疗的证据的缺乏。然而，目前的共识文件建议评估所有内科和外科患者的血栓栓塞风险，并根据风险水平提供预防建议，风险水平由不同的临床和分子风险因素确定。虽然长期的潜在临床和分子风险因素也对内科患者的总体风险有重大影响;但风险显然随医疗条件的类型而变化。心肌梗死、中风和恶性疾病与静脉血栓栓塞的高发生率有关;最近的证据强调心肺疾病患者是一个独特的风险群体。尽管在某些方面持怀疑态度，高质量的证据证实了普通肝素（UFH）和低分子量肝素（LMNVH）在减少广泛的医疗患者的无症状深静脉血栓形成（DVT）方面的疗效;需要进一步的研究来阐明对致命性肺栓塞（PE）的影响。最近PRINCE和MEDENOX研究的新数据表明，LMWH依诺肝素可有效预防重度心肺疾病患者的VTE，且耐受性良好。在最近的血栓预防共识会议上，新出现的证据已导致对这些患者使用血栓预防的1A级建议。然而，需要进一步的研究来阐明内科患者预防的最佳持续时间，并评估门诊预防的潜在作用。根据精心设计的对照临床试验的证据，选择准确的风险评估和及时实施适当的预防措施，可能会降低医疗患者未来因VTE导致的发病率和死亡率。
In medical patients, the risk of venous thromboembolism (VTE) is substantially underestimated and prophylaxis is used far less than in surgical patients, reflecting the scarcity of evidence supporting antithrombotic therapy in nonsurgical settings. However, current consensus documents recommend assessment of all medical, as well as surgical, patients for thromboembolic risk and provide prophylaxis recommendations according to the risk level, determined by the presence of different clinical and molecular risk factors. Although long-term, underlying clinical and molecular risk factors also have a major impact on overall risk in medical patients; risk clearly varies with the type of medical condition. Myocardial infarction, stroke, and malignant disease are linked to a high rate of VTE; recent evidence highlights patients with cardiopulmonary, disease as a distinct risk group. Despite skepticism in some quarters, high-quality evidence confirms the efficacy of unfractionated heparin (UFH) and low-molecular-weight heparins (LMNVH) in reducing asymptomatic deep vein thrombosis (DVT) in a broad spectrum of medical patients; further studies are required to clarify the effect on fatal pulmonary embolism (PE). Emerging data from the recent PRINCE and MEDENOX studies demonstrate that the LMWH enoxaparin provides effective and well-tolerated VTE prevention in patients with severe cardiopulmonary, disease. Emerging evidence has led to a grade 1A recommendation for the use of thromboprophylaxis in these patients in the most recent consensus conference on thromboprophylaxis. Further studies, however, are required to clarify the optimal duration of prophylaxis in medical patients and to evaluate the potential role of outpatient prophylaxis. Accurate risk assessment and prompt implementation of appropriate prophylaxis, selected on the basis of evidence from well-designed controlled clinical trials, may reduce the future morbidity and mortality due to VTE in medical patients.