小结
定义
病史和体格检查
关键诊断因素
- 既往有静脉血栓栓塞、易栓症、恶性肿瘤、手术后、外伤以及中心静脉置管
- 慢性疾病、麻痹、高龄、肥胖、含雌激素避孕药和激素替代治疗、静脉曲张、妊娠和产后 ≤ 6 周、一级亲属有 VTE 病史、长时间旅行以及入院接受重症监护治疗
危险因素
- 既往静脉血栓栓塞（深静脉血栓形成 [DVT] 和/或肺栓塞 [PE]）
- 血栓形成倾向
- 恶性肿瘤
- 术后情况
- 外伤
- 内置的中心导管（上肢或下肢）
- 丧失活动能力
- 骨髓增生性疾病
- 充血性心力衰竭
- 慢性阻塞性肺疾病
- 炎症性肠病
- 肢体轻度瘫痪患者的神经系统疾病
- 年龄增长
- 肥胖
- 含雌激素避孕药、激素替代治疗（HRT）和雄激素剥夺治疗
- 静脉曲张病史
- 妊娠/产后
- 长途旅行
- 小腿固定
- 一级亲属有 VTE 病史
- 入院接受重症监护
诊断性检查
首要检查
- 全血细胞计数 (FBC)
- 血清肌酐
- INR
- PTT
需考虑的检查
- 血清抗血小板因子4抗体
治疗流程
所有存在风险的患者
外伤患者
外科手术患者
内科患者
撰稿人
作者
Nathalie Routhier, MD, MSc, FRCPC
Attending Physician
Assistant Professor
University of Montreal
Montreal
Canada
利益声明
NR declares that she has no competing interests.
Vicky Tagalakis, MD, FRCPC, MSC
Associate Professor
General Internal Medicine Program Director
McGill University Division of Internal Medicine
Centre for Clinical Epidemiology of the Lady Davis Institute for Medical Research
Jewish General Hospital
Montreal
Canada
利益声明
VT declares that she has received an investigator-initiated grant from Sanofi-Aventis. She has also received consultancy fees from and given lectures sponsored by Bristol-Myers Squibb, Pfizer, Sanofi-Aventis, and Servier. VT is an author of references cited in this topic.
鸣谢
Dr Nathalie Routhier and Dr Vicky Tagalakis would like to gratefully acknowledge Dr Vincent Bouchard-Dechêne and Dr Adi J. Klil-Drori, previous contributors to this topic.
利益声明
VBD and AJKD declare no competing interests.
同行评议者
Andrew Parfitt, MBBS, FFAEM
Clinical Director
Acute Medicine
Associate Medical Director
Consultant Emergency Medicine
Guy's and St Thomas' NHS Foundation Trust
Clinical Lead and Consultant
Accident Emergency Medicine
St Thomas' Hospital
London
UK
利益声明
AP declares that he has no competing interests.
Sudeep Shivakumar, MD
Hematologist
Thrombosis Fellow
University of Ottawa
Ottawa Health Research Institute
Ottawa
Canada
利益声明
SS declares that he has no competing interests.
指南
- 癌症患者的静脉血栓栓塞预防与治疗：美国临床肿瘤学会临床实践指南更新
- 呼吁采取行动预防住院患者发生静脉血栓栓塞：美国心脏协会发布的政策声明
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