最后审阅: 19 九月 2021
最后更新: 22 四月 2021

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
  • 抗磷脂抗体综合征
  • 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
  • 近端多普勒超声
  • 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

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 declares that he has no competing interests.

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 (CHEST) guideline on the treatment of venous thrombotic disease.

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.

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