静脉血栓栓塞症危险因素2012526.ppt

美国每年至少2百万新发VTE，其中1/10的患者死亡 * Figure 1. Results of Trials of Prophylaxis for Venous Thromboembolism in High-Risk Hospitalized Patients. In three randomized, double-blind trials, enoxaparin, dalteparin, or fondaparinux was compared with placebo for the prevention of venous thromboembolism. The use of the anticoagulant resulted in significantly decreased rates of thromboembolism in the Prophylaxis in Medical Patients with Enoxaparin (MEDENOX) trial (P0.001),7 the Prospective Evaluation of Dalteparin Efficacy for Prevention of VTE in Immobilized Patients Trial (PREVENT) (P = 0.002),8 and the Arixtra for Thromboembolism Prevention in a Medical Indications Study (ARTEMIS) (P = 0.03).6 Relative risk reductions are shown for patients receiving each prophylactic drug as compared with those receiving placebo. * 26% of unrecognized pulmonary embolisms are eventually fatal. P.E. accounts for 16% of all hospital death * Who and how * Virchows triad. Professional illustration by Kenneth X. Probst. * * * * APC-R活化的蛋白C抵抗 停止抗凝治疗复发的风险 * 出现VTE患者，口服抗凝治疗第1次，3-6月，第2次 6-12月，第3次，长期，甚至终身抗凝治疗。 * 长时间制动引起下肢静脉血液淤积，饮水减少导致血液粘稠度增加, Recent travel (within prior 2weeks, 4 hrs). 《15岁，VTE发病率5/10万，》80岁450-600/10万（0.5%），与体力活动减少、肌张力减低、疾病增加和血管内皮功能减弱有关 妊娠期和产褥期VTE71-85/10万，PTE15/10万，致死PE1/10万 产褥期发生静脉血栓的危险性亦 增加且比妊娠期危险性更高!妊娠后下肢静脉回 流障碍多种凝血因子活性增强活动减少等是易栓 倾向的原因! * Incidence of venous thromboembolism per 100?000 person years by sex and age, with error bars representing 95% confidence intervals * Travel 4 hr in the 8 weeks preceding the thrombotic event. Risk is the similar among all mode of traveling, car, bus, train, or flight. Conditional logistic regression analysis was performed to calculate odds ratios, to account for all factors in which cases and controls are similar * 梯度弹力袜 * 手术对组织、血管壁的损伤导致凝血系统激活，麻醉、体外循环造成血流缓慢、输血引起血液粘稠度增加 麻醉时间30分钟的腹部或胸部手术是VTE的独立危险因素 髋、膝关节置换术、泌尿系统手术、神经外科手术及妇产科手术，VTE发生风险增加6-22倍 严重创伤增加13倍 骨折、脊髓损伤、头颅损伤 30-60%，致死性PE0.4-2.0% 严重头部损伤、昏迷、脊髓损伤、骨盆和长骨骨折PTE较其他创伤患者高21-54倍 ICU中30%DVT未得到抗凝治疗，15%发生PTE，