小结
定义
病史和体格检查
关键诊断因素
- 小腿肿胀
- 沿着深静脉走向的局部疼痛
其他诊断因素
- 非对称性水肿
- 浅静脉突出
- 全腿肿胀
- 股青肿
危险因素
- 过去 3 个月内大手术史
- 过去 2 个月内住院史
- 活动性肿瘤
- 既往有静脉血栓栓塞病史
- 有近期外伤或骨折病史
- 年龄增长
- 妊娠期和产后期
- 下肢瘫痪
- 凝血因子 V Leiden
- 凝血酶原基因 G20210A 突变
- 蛋白质 C 或 S 缺乏
- 抗凝血酶缺乏
- 抗磷脂综合征
- 内科合并症
- 特定药物的使用
- 肥胖
- 吸烟
- 近期长距离空中旅行
- 家族史
- 中心静脉置管
诊断性检查
首要检查
- Wells 评分
- D-二聚体水平定量检测
- 近端双功超声
- 全腿超声检查
- 国际标准化比率和活化部分凝血活酶时间
- 尿素和肌酐
- 肝功能检查 (LFT)
- 全血细胞计数（FBC）
需考虑的检查
- 多普勒静脉血流测定
- 腹部和盆腔 CT 造影增强扫描
- 血栓形成倾向的筛查
治疗流程
初始阶段治疗：无活动性出血
初始阶段治疗：活动性出血
治疗阶段治疗
延长期治疗（已完成 3 个月的抗凝治疗）：非产后，无复发
延长阶段治疗：出生后（打算母乳喂养）
延长阶段治疗：出生后（不打算母乳喂养）
延长阶段治疗：复发性 VTE
撰稿人
作者
Scott M. Stevens, MD
Director
Thrombosis Clinic
Intermountain Medical Center
Murray
Professor of Medicine
Department of Medicine
Intermountain Healthcare and University of Utah
Salt Lake City
UT
利益声明
SMS serves as co-chair of the American College of Chest Physicians guideline on the treatment of venous thrombotic disease. He is the author of several references cited in this topic.
Scott C. Woller, MD
Director
Thrombosis Clinic
Intermountain Medical Center
Murray
Professor of Medicine
Department of Medicine
Intermountain Healthcare and University of Utah
Salt Lake City
UT
利益声明
SCW serves as co-chair of the American College of Chest Physicians guideline on the treatment of venous thrombotic disease. He is the author of several references cited in this topic.
Gabriel V. Fontaine, PharmD, MBA, BCPS
Clinical Pharmacy Manager
Critical Care and Emergency Medicine
Advanced Clinical Pharmacist
Neuroscience Critical Care
Intermountain Medical Center
Murray
UT
利益声明
GVF has received consulting fees and honoraria from Alexion Pharmaceuticals.
鸣谢
Dr Scott M. Stevens, Dr Scott C. Woller, and Dr Gabriel V. Fontaine would like to gratefully acknowledge Dr Geno Merli, Dr Taki Galanis, Dr Luis Eraso, Dr Geoffrey Ouma, Dr Richard White, and Dr Windsor Ting, the previous contributors to this topic.
利益声明
GM has received grant or research support from BMS, J&J, Sanofi-Aventis, Portola, and Janssen; he has served as a Scientific Consultant for BMS, J&J, and Sanofi-Aventis. RW declares participation in numerous multicentred clinical trials sponsored by companies: Agenix, Boehringer-Ingleheim, Amgen, Bayer, Bristol-Meyer-Squibb, Novartis, Hemosense. TG, LE, GO, and WT declare that they have no competing interests.
同行评议者
Beverly Hunt, FRCP, FRCPath, MD
Professor of Thrombosis & Haemostasis
King's College
Consultant
Departments of Haematology, Pathology & Rheumatology
Lead in Blood Sciences
Guy's & St Thomas' NHS Foundation Trust
London
UK
利益声明
BH declares that she has no competing interests.
鉴别诊断
- 蜂窝织炎
- 腓肠肌撕裂/跟腱撕裂
- 腓肠肌血肿
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- 美国血液病学会 2021 年静脉血栓栓塞管理指南：癌症患者的预防和治疗
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