How we diagnose and treat deep vein thrombosis
How we diagnose and treat deep vein thrombosis
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DOI：
10.1182/blood.v99.9.3102
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发表时间：
2002-05-01
期刊：
影响因子：
20.3
通讯作者：
Lee, AYY
中科院分区：
文献类型：
--
作者：
Hirsh, J;Lee, AYY
诊断深静脉血栓形成（DVT）需要临床评估和客观测试，因为临床特征是非特异性的，检查可能是假阳性或阴性。诊断过程的第一步是使用经验证的临床模型将患者分为高风险、中等风险或低风险类别。当临床概率为中或高，且静脉超声结果为阳性时，确认为急性症状性DVT。同样，当概率较低且超声结果正常时，排除DVT。低临床概率结合阴性D-二聚体结果也可用于排除DVT，从而避免超声检查的需要。相反，当临床评估与客观测试结果不一致时，需要进行连续静脉超声检查或静脉造影以确认或否定DVT的诊断。一旦患者被诊断为急性DVT，低分子量肝素（LMWH）是初始治疗的首选药物，口服抗凝剂治疗是长期二级预防的标准。治疗应持续至少3个月;通过权衡复发性血栓形成和抗凝剂相关出血的风险，并受患者偏好的影响，决定是否继续治疗超过3个月。相关血栓形成倾向的筛查并不常规，但应在临床特征提示潜在高凝状态的选定患者中进行。在静脉血栓栓塞患者的III期研究中，正在对几种理论上优于现有药物的新型抗凝剂进行评价。(C)2002年，美国血液学会。
Making a diagnosis of deep vein thrombosis (DVT) requires both clinical assessment and objective testing because the clinical features are nonspecific and Investigations can be either falsely positive or negative. The Initial step in the diagnostic process is to stratify patients Into high-, Intermediate-, or low-risk categories using a validated clinical model. When the clinical probability is intermediate or high and the venous ultrasound result is positive, acute symptomatic DVT is confirmed. Similarly, when the probability is low and the ultrasound result Is normal, DVT is ruled out. A low clinical probability combined with a negative D-dimer result can also be used to rule out DVT, thereby obviating the need for ultrasonography. In contrast, when the clinical assessment Is discordant with the results of objective testing, serial venous ultrasonography or venography is required to confirm or refute a diagnosis of DVT. Once a patient Is diagnosed with an acute DVT, low-molecular-weight heparin (LMWH) is the agent of choice for Initial therapy and oral anticoagulant therapy is the standard for long-term secondary prophylaxis. Therapy should continue for at least 3 months; the decision to continue treatment beyond 3 months is made by weighing the risks of recurrent thrombosis and anticoagulant-related bleeding, and Is Influenced by patient preference. Screening for associated thrombophilia is not Indicated routinely, but should be performed In selected patients whose clinical features suggest an underlying hypercoagulable state. Several new anticoagulants with theoretical advantages over existing agents are undergoing evaluation in phase 3 studies in patients with venous thromboembolism. (C) 2002 by The American Society of Hematology.