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首页> 外文期刊>Drug Design, Development and Therapy >Prevention of venous thromboembolism in hospitalized acutely ill medical patients: focus on the clinical utility of (low-dose) fondaparinux
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Prevention of venous thromboembolism in hospitalized acutely ill medical patients: focus on the clinical utility of (low-dose) fondaparinux

机译：预防住院急症内科患者的静脉血栓栓塞：关注（低剂量）磺达肝素的临床应用

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Abstract: Venous thromboembolism (VTE) is a frequent complication among acutely ill medical patients hospitalized for congestive heart failure, acute respiratory insufficiency, rheumatologic disorders, and acute infectious and/or inflammatory diseases. Based on robust data from randomized controlled studies and meta-analyses showing a reduced incidence of VTE by 40% to about 60% with pharmacologic thromboprophylaxis, prevention of VTE with low molecular weight heparin (LMWH), unfractionated heparin (UFH), or fondaparinux is currently recommended in all at-risk hospitalized acutely ill medical patients. In patients who are bleeding or are at high risk for major bleeding, mechanical prophylaxis with graduated compression stockings or intermittent pneumatic compression may be suggested. Thromboprophylaxis is generally continued for 6 to 14 days or for the duration of hospitalization. Selected cases could benefit from extended thromboprophylaxis beyond this period, although the risk of major bleeding remains a concern, and additional studies are needed to identify patients who may benefit from prolonged prophylaxis. For hospitalized acutely ill medical patients with renal insufficiency, a low dose (1.5 mg once daily) of fondaparinux or prophylactic LMWH subcutaneously appears to have a safe profile, although proper evaluation in randomized studies is lacking. The evidence on the use of prophylaxis for VTE in this latter group of patients, as well as in those at higher risk of bleeding complications, such as patients with thrombocytopenia, remains scarce. For critically ill patients hospitalized in intensive care units with no contraindications, LMWH or UFH are recommended, with frequent and careful assessment of the risk of bleeding. In this review, we discuss the evidence for use of thromboprophylaxis for VTE in acutely ill hospitalized medical patients, with a focus on (low-dose) fondaparinux.
机译：摘要：静脉血栓栓塞症（VTE）是因充血性心力衰竭，急性呼吸功能不全，风湿病以及急性感染和/或炎性疾病住院的急病医疗患者中的常见并发症。基于来自随机对照研究和荟萃分析的可靠数据，结果显示，通过药理性血栓预防，低分子量肝素（LMWH），普通肝素（UFH）或磺达肝素预防VTE发生率可降低40％至60％。目前推荐用于所有有风险的住院急症内科患者。对于有出血或严重出血风险高的患者，建议进行机械预防，使用渐进式加压袜或间歇性气压加压。预防血栓一般要持续6到14天或住院期间。尽管仍然存在严重出血的风险，但选择的病例可能会在这段时期内受益于延长的血栓预防治疗，并且还需要进一步的研究来确定可能从长期预防中获益的患者。对于住院的肾功能不全的急症内科患者，尽管在随机研究中缺乏适当的评估，但低剂量（每天一次1.5 mg）磺达肝癸钠或预防性LMWH皮下注射似乎具有安全性。在后一类患者以及出血并发症风险较高的患者（如血小板减少症患者）中，尚无预防性使用VTE的证据。对于在重症监护病房住院且没有禁忌症的重症患者，建议使用LMWH或UFH，并经常仔细评估出血风险。在这篇综述中，我们讨论了在急性病住院的医疗患者中使用血栓预防性VTE的证据，重点是（低剂量）磺达肝素。

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