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深静脉血栓形成

Last reviewed: 22 Sep 2024
Last updated: 04 Oct 2023

Summary

Definition

History and exam

Key diagnostic factors

  • 小腿肿胀
  • 沿着深静脉走向的局部疼痛
Full details

Other diagnostic factors

  • 非对称性水肿
  • 浅静脉突出
  • 全腿肿胀
  • 股青肿
Full details

Risk factors

  • 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
Full details

Diagnostic tests

1st tests to order

  • 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)
Full details

Tests to consider

  • 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
Full details

Treatment algorithm

INITIAL

初始阶段治疗:无活动性出血

初始阶段治疗:活动性出血

ACUTE

治疗阶段治疗

ONGOING

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

Contributors

Authors

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

Disclosures

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

Disclosures

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

Disclosures

GVF has received consulting fees and honoraria from Alexion Pharmaceuticals.

Acknowledgements

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.

Disclosures

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.

Peer reviewers

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

Disclosures

BH declares that she has no competing interests.

  • 深静脉血栓形成 images
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    • 腓肠肌血肿
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  • Guidelines

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    • 癌症患者的静脉血栓栓塞的预防及处理
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  • Patient information

    深静脉血栓形成

    DVT 和长途旅行

    More Patient information
  • Calculators

    深静脉血栓形成 (DVT) 改良 Wells 评分

    肝素致血小板减少的验前概率(4 T 评分)

    More Calculators
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