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首页> 外文期刊>Current opinion in anaesthesiology >Update in the prevention and treatment of deep vein thrombosis and pulmonary embolism.
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Update in the prevention and treatment of deep vein thrombosis and pulmonary embolism.

机译：深静脉血栓形成和肺栓塞的预防和治疗方面的最新进展。

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摘要

PURPOSE OF REVIEW: Thromboembolic events have a major impact on outcome of surgical and medical patients. This review is focused on standards and recent advances in antithrombotic strategies for prevention and therapy of venous thromboembolism and pulmonary embolism. RECENT FINDINGS: Alert programs improve prophylactic strategies to prevent venous thromboembolism. Evidenced-based guidelines are available on antithrombotic and thrombolytic therapy outweighing the benefits, risks, burdens and costs. Selective factor Xa and direct thrombin inhibitors are at least as effective as low-molecular-weight heparin in prevention of venous thromboembolism and treatment of pulmonary embolism, but have fewer side effects and will not need routine monitoring. In high-risk orthopaedic patients but not in general surgery patients fondaparinux is superior to low-molecular-weight heparin in the prevention of thromboembolic disease. Ximelagatran, the first oral direct thrombin inhibitor, is as effective and well tolerated as warfarin. Long-term treatment is uncertain, however, because of elevation in alanine transaminase levels. In high-risk patients with contraindication for anticoagulation, retrievable vena cava filters may be an option to prevent pulmonary embolism. Permanent cava filters do not improve long-term survival and are associated with relevant side effects. Thrombolytics should be reserved for deep venous thrombosis complicated by limb gangrene and for life threatening pulmonary embolism. SUMMARY: There is currently sufficient information based on guidelines available on preventive and therapeutic strategies for venous thromboembolism and pulmonary embolism. Antithrombotics are the therapeutic backbone. In high-risk orthopedic surgery and venous thromboembolism the new antithrombotics fondaparinux, idraparinux and ximelagatran are superior to standard treatment. Temporary caval filters may be a therapeutic option in high-risk patients with contraindication for antithrombotics.
机译：审查目的：血栓栓塞事件对手术和医学患者的预后有重大影响。这项审查的重点是在预防和治疗静脉血栓栓塞和肺栓塞的抗血栓形成策略的标准和最新进展。最近的发现：警报程序改善了预防策略，以预防静脉血栓栓塞。在抗血栓和溶栓治疗方面，有基于证据的指导方针可胜于其益处，风险，负担和成本。选择因子Xa和直接凝血酶抑制剂在预防静脉血栓栓塞和治疗肺栓塞方面至少与低分子量肝素一样有效，但副作用较少，不需要常规监测。在高风险的骨科患者中，但在普通手术患者中，磺达肝癸钠在预防血栓栓塞性疾病方面优于低分子量肝素。 Ximelagatran是第一种口服直接凝血酶抑制剂，与华法林一样有效且耐受良好。然而，由于丙氨酸转氨酶水平升高，长期治疗尚不确定。对于有抗凝禁忌症的高危患者，可取下的腔静脉滤器可能是预防肺栓塞的一种选择。永久性静脉滤器不能提高长期生存率，并且会产生相关的副作用。溶栓剂应保留用于深静脉血栓形成并伴有肢体坏疽和危及生命的肺栓塞。摘要：目前有足够的信息基于关于静脉血栓栓塞和肺栓塞的预防和治疗策略的指南。抗血栓形成剂是治疗的骨干。在高风险的整形外科手术和静脉血栓栓塞中，新的抗血栓形成药磺达肝癸钠，伊达肝癸钠和西美加群优于标准治疗。对于具有抗血栓形成禁忌症的高危患者，临时性滤过器过滤器可能是一种治疗选择。

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