静脉血栓栓塞性疾病规范性药物治疗

Standardization drug therapy of venous thromboembolism

静脉血栓栓塞性疾病(VTE)包括深静脉血栓形成(DVT)和肺栓塞(PE)。抗凝是VTE的基础治疗。目前国内大多数VTE的抗凝方案是普通肝素或低分子质量肝素继以口服维生素K拮抗剂。近些年来新的口服抗凝药相继问世,包括直接凝血酶抑制剂,如达比加群、Ⅹa因子抑制剂和利伐沙班。这些药物可以固定剂量口服而不需要监测。偱证医学支持个性化的抗凝方案壳傲俅采峡晒┭择的溶栓药物包括链激酶、尿激酶和阿替普酶。对于急性中央型DVT推荐行导管直接溶栓,以减轻症状和血栓后综合征的发生。在抗凝治疗的同时可酌情给予抗血小板药物和改善微循环药物。

Venous thromboembolism （VTE） is a spectrum of diseases that includes deep vein thrombosis （DVT） and pulmonary embolism （PE）. Anticoagulant treatment is the mainstay of therapy for VTE. Unfractionated heparin （UFH） or low molecular weight heparin （LMWH） followed by vitamin K antagonists have been the treatment of choice for most patients with VTE in China. Over the last years, new oral anticoagulant agents including direct factor Ila inhibitors, such as dabigatran and direct factor Xa inhibitors, such as rivaroxaban have been developed. The drugs are taken orally at fixed daily doses and do not require laboratory monitoring. According to evidence-based medicine, individual anticoagulation is recommended. So far, the available thrombolytic agents are streptokinase, urokinase and aheplase. In selected patients with extensive acute proximal DVT, catheter-directed thrombolysis （CDT） is recommemted to reduce acute symptoms and postthrombotie morbidity. Antiplatelet agents and microcirculation improvement drugs could be used after anticoagulation.