静脉血栓栓塞症 venous thromboembolism - PubMed 文献(第 5 页)
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Race against clots: the challenges of managing antithrombin deficiency in the ICU.
We present the case of a man in his 50s with a history of recurrent unprovoked venous thromboembolism who developed haemorrhagic shock due to venous intestinal ischaemia. Despite anticoagulation and monitoring of anti-Xa levels, the thrombosis progressed, leading to complete necrosis and perforation of the small bowel wall, persistent septic shock and ultimately death. The clinical course and family history raised suspicion for hereditary antithrombin deficiency, a rare but potentially catastrophic thrombophilia. This case highlights the importance of considering inherited thrombophilia in critically ill patients with progressive thrombosis despite adequate anticoagulation, and the challenges of managing these conditions in the intensive care unit.
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Venous Thromboembolism in Patients with Heart Failure.
Heart failure (HF) and venous thromboembolism (VTE) are common clinical entities, closely interrelated, sharing multiple pathophysiological mechanisms. Their co-incidence is associated with further worsening of the prognosis of one another. Despite their frequent co-existence, important clinical questions still remain unanswered. The risk of VTE especially in chronic HF patients appears to vary widely in clinical studies, while the VTE-associated risk in HF patients is still not well determined and cannot be accurately predicted. Although scientific guidelines recommend venous thromboprophylaxis in patients hospitalized with an acute HF syndrome, venous thromboprophylaxis has not been studied adequately in prospective trials in ambulatory HF patients. In the present review, we aimed to summarize the current knowledge on the epidemiology of VTE and HF, the risk prediction for VTE occurrence in HF patients, the impact on patient outcome, and the need for anticoagulation in certain HF subgroups to improve prognosis, while we sought to identify gaps in knowledge that need to be addressed in the future.
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Bleeding complications during anticoagulant treatment in patients with cancer.
Patients with cancer have an increased risk of bleeding complications, of which some are fatal. This risk is influenced by chemotherapy, cancer type and stage, thrombocytopenia, renal function, and previous bleeding. Since many cancer patients receive anticoagulant treatment for prophylaxis or treatment of venous thromboembolism (VTE), bleeding complications are a challenge in clinical practice. This review article focuses on the overall bleeding risk of cancer patients and the risk of major and clinically relevant bleeding associated with anticoagulant treatment, such as vitamin K antagonists, LMWH and the direct oral anticoagulants. It also describes strategies for individual risk assessments.
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Risk and prophylaxis of venous thromboembolism in hospitalized psychiatric patients. A review.
Venous thromboembolism (VTE) is a frequent dangerous complication occurring during hospital treatment with total annual incidence of 70-200 per 100,000 citizens. Venous thromboembolism includes deep vein thrombosis (DVT) and pulmonary embolism (PE). Pulmonary embolism is responsible for about 10% of hospitalization-related deaths and is the most common avoidable reason for deaths in hospitals. Psychiatric inpatients are particularly vulnerable to an increased risk of VTE due to their limited mobility, the use of restraints, catatonia, communication difficulties, and the use of antipsychotics. Patients with chronic psychiatric conditions like schizophrenia and recurrent affective disorders have significantly higher somatic comorbidity. This population of patients requires specific approach to VTE prophylaxis during hospitalization. This article offers an insight into issues related to thromboembolism, and presents validated diagnostic tools and VTE prophylaxis strategies. The paper includes the review of available research on VTE in patients hospitalized for psychiatric reasons. Considering the scarcity of specific studies in this population we highlight the necessity to follow the available general medical guidelines for psychiatric inpatients.
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Spontaneous acute superficial vein thrombosis of the legs: do we really need to treat?
Spontaneous acute superficial vein thrombosis (SVT) of the leg is now generally recognized as an integral component of venous thromboembolic disease with potentially severe consequences. However, the relatively low grades of some current international recommendations and uncertainty regarding the cost-effectiveness of available therapies may prompt questioning of the real need to treat patients with SVT and explain the persisting heterogeneity of their management in practise. Yet several studies have consistently shown high rates of thromboembolic complications associated with SVT, whether at first presentation or during follow-up. The CALISTO trial established for the first time the clinical benefit of a well-defined anticoagulant regimen for the prevention of serious thromboembolic complications in SVT patients, and we believe that patients such as those included in this trial should receive this regimen as tested. However, several areas of uncertainty remain for categories of SVT patients not evaluated in CALISTO.
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Venous thromboembolism in pregnancy.
In Western nations, venous thromboembolism (VTE) is an important cause of morbidity and the most common cause of maternal death during pregnancy and the puerperium. Pregnancy is a hypercoagulable state in which coagulation is activated and thrombolysis inhibited. This prothrombotic risk is compounded when hereditary and acquired thrombophilias and other prothrombotic risk factors are present. The risk of venous thrombotic events is increased fivefold during pregnancy and 60-fold in the first 3 months after delivery (postpartum period) compared with nonpregnant women. Many of the signs and symptoms of VTE overlap those of a normal pregnancy, which complicates the diagnosis. Patients with history of previous VTE should use graduated compression stockings throughout pregnancy and the puerperium, and should receive postpartum anticoagulant prophylaxis. The indications for antepartum anticoagulant prophylaxis are somewhat controversial. This article reviews the management of VTE during pregnancy and in the postpartum period.
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Association between gastroesophageal reflux disease and venous thromboembolism: A Mendelian randomization study.
The link between gastroesophageal reflux disease (GERD) and venous thromboembolism (VTE) is not well understood. We performed a 2-sample Mendelian randomization (MR) study to explore the potential causal effect of GERD on VTE. To explore the causal relationship between genetically predicted GERD and the risk of VTE, including pulmonary embolism (PE) and deep vein thrombosis (DVT). Three MR statistical techniques (inverse variance weighting (IVW), weighted median, and MR-Egger) were used to evaluate the potential causal relationship in genome-wide association studies. As part of the sensitivity analysis, we assessed heterogeneity and pleiotropy, and used the leave-one-SNP-out method to enhance the robustness of our findings. MR analysis results indicated that genetically predicted GERD was associated with an increased risk of venous thromboembolism (odds ratio [OR] = 1.239, 95% confidence interval [CI] = 1.146-1.339), PE (OR = 1.307, 95% CI = 1.156-1.477) and DVT (OR = 1.160, 95% CI = 1.012-1.330). Moreover, this study did not detect any heterogeneity or pleiotropy. GERD has a causal effect on venous thromboembolism, PE, and DVT.
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Venous thromboembolism prophylaxis in traumatic brain injury after radiographic progression: a 6-year experience at a single Canadian Level 1 trauma Centre.
Patients with traumatic brain injury are at high risk for venous thromboembolism. Therefore, pharmacological prophylaxis for venous thromboembolism has become critical in managing trauma patients. Unfortunately, the decision to initiate prophylaxis in patients with radiographic progression must be carefully weighed against the risk of further progression of intracranial haemorrhage, with little evidence to support decision-making. A retrospective review was performed at a Canadian Level 1 Trauma Centre from 2011-2017. Included adult patients had evidence of radiographic intracranial haemorrhage progression on repeat CT, and patients receiving prophylaxis were compared with those not having received prophylaxis. Regression analyses were performed to determine the decision-making process for providers when caring for these patients. 242 patients were included in the study, with 33.1% of these patients not receiving pharmacological prophylaxis during admission. Of those without prophylaxis, 1.2% developed deep vein thromboses, no patients with pulmonary emboli, compared with five patients in the prophylaxis group with pulmonary emboli. The probability of not receiving prophylaxis was higher if abbreviated injury score is greater or equal to 4, decreased in cases of pelvic fracture or solid organ injury, or if the patient required an operative procedure. Patients with isolated, non-operative severe traumatic brain injury may be at risk of not receiving pharmacologic prophylaxis for venous thromboembolism during hospital admission. This decision may place patients at greater risk of venous thromboembolism, and thereby increased morbidity and mortality. As such, further investigation and initiatives to improve pharmacologic prophylaxis in this patient population is warranted.
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Venous thromboembolism in orthopedic surgery: Global guidelines. 骨科手术中的静脉血栓栓塞：全球指南
Venous thromboembolism (VTE) is a severe complication that can occur after major orthopedic procedures. As VTE-related morbidity and mortality are a significant concern for both medical professionals and patients, and preventative measures are typically employed. Multiple organizations, including the American College of Chest Physicians (ACCP) and the American Academy of Orthopedic Surgeons (AAOS), have developed guidelines for VTE prophylaxis specifically in patients undergoing joint replacement procedures. However, recently, the International Consensus Meeting (ICM) was convened, which brought together over 600 experts from 68 countries and 135 international societies. These experts, spanning a range of medical disciplines including orthopedic surgery, anesthesia, cardiology, hematology, vascular, and internal medicine, conducted a comprehensive review of the literature using a strict Delphi process to generate practical recommendations for VTE prophylaxis across all types of orthopedic procedures. This review article summarizes some of the recommendations of the ICM.
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Clinical decision rules in venous thromboembolism.
Current prevention, diagnostic management and therapeutic management strategies for venous thromboembolism (VTE) almost all include an assessment of the clinical probability. Clinical decision rules (CDRs) are decision making tools using combinations of simple available clinical predictors to define a probability of an outcome which can be used in a preventative strategy, diagnostic course of action or therapeutic course of action. CDRs provide accurate and reproducible estimates of clinical outcomes. The best performing CDRs are built and validated following strict methodological standards. In this paper we critically review the use of CDRs in prevention, diagnosis and treatment of VTE and highlight those CDRs that are ready for the prime time of daily clinical use.