抗血栓形成的治疗静脉血栓栓塞疾病:美国胸科医师学会循证临床实践指南(第八版)。

文章的细节

引用
复制到剪贴板

老Kearon C,卡恩,阿涅利G, Goldhaber年代,Raskob通用电气、Comerota AJ

抗血栓形成的治疗静脉血栓栓塞疾病:美国胸科医师学会循证临床实践指南(第八版)。

胸部。2008年6月,133(6):454 - 545年代。doi: 10.1378 / chest.08 - 0658。

PubMed ID
18574272 (在PubMed
]
文摘

本章对治疗静脉血栓栓塞疾病的一部分,美国胸科医师学会循证临床实践指南(第八版)。1级建议强劲,表明,做或不做的好处大于风险,负担,和成本。2级值表明,个别患者可能导致不同的选择(分级的完整理解,看到“等级的建议”一章)。在本章主要建议如下:客观证实患者深静脉血栓形成(DVT)或肺栓塞(PE),我们建议抗凝治疗与皮下(SC)使用低分子肝素(LMWH),监控四世或SC依诺肝素钠(能),监测体重依赖型剂量SC超高频或SC fondaparinux(1级)。高患者深静脉血栓形成的临床怀疑或体育,我们建议用抗凝剂治疗等待诊断测试的结果(等级1 c)。证实PE患者,我们推荐早期溶栓治疗的风险效益评估(1 c级);对于血流动力学妥协,我们建议:溶栓治疗(1 b级);nonmassive PE患者,我们推荐使用的溶栓治疗(1 b级)。在急性深静脉血栓形成或体育,我们建议初始LMWH治疗,超高频或fondaparinux至少5天,而不是一个短期内(1 c级);和起始的维生素K拮抗剂(VKAs)加上LMWH,超高频,或fondaparinux第一天,治疗,停药肝素制剂,以国际标准化比率(INR) >或至少24 h = 2.0 (1 a级)。 For patients with DVT or PE secondary to a transient (reversible) risk factor, we recommend treatment with a VKA for 3 months over treatment for shorter periods (Grade 1A). For patients with unprovoked DVT or PE, we recommend treatment with a VKA for at least 3 months (Grade 1A), and that all patients are then evaluated for the risks to benefits of indefinite therapy (Grade 1C). We recommend indefinite anticoagulant therapy for patients with a first unprovoked proximal DVT or PE and a low risk of bleeding when this is consistent with the patient's preference (Grade 1A), and for most patients with a second unprovoked DVT (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 at least 3 months of treatment with LMWH for patients with VTE and cancer (Grade 1A), followed by treatment with LMWH or VKA as long as the cancer is active (Grade 1C). For prevention of postthrombotic syndrome (PTS) after proximal DVT, we recommend use of an elastic compression stocking (Grade 1A). For DVT of the upper extremity, we recommend similar treatment as for DVT of the leg (Grade 1C). Selected patients with lower-extremity (Grade 2B) and upper-extremity (Grade 2C). DVT may be considered for thrombus removal, generally using catheter-based thrombolytic techniques. For extensive superficial vein thrombosis, we recommend treatment with prophylactic or intermediate doses of LMWH or intermediate doses of UFH for 4 weeks (Grade 1B).

DrugBank数据引用了这篇文章

药物