血栓性疾病诊断11—培训课件.pptVIP

* Measurement of D-Dimer may serve as an aid in the clinical diagnosis and management of thrombotic disorders. Three classes of thrombotic conditions can be distinguished: disseminated intravascular coagulation (DIC) arterial thrombosis venous thromboembolism (VTE) which is comprised of deep vein thrombosis (DVT) and Pulmonary embolism (PE) * The third most common cardiovascular disease (after ischemic syndromes and stroke). VTE may be expressed as a condition known as deep vein thrombosis (DVT), which may further develop into a potentially fatal pulmonary embolism (PE) Shown angiogram of Pulmonary Embolism (autopsy) * DVT can be seen proximally - above the knee, or more commonly, distally, confined to the calf veins. Most PE are due to embolization from the proximal leg veins rather than the distal calf veins Note also, thrombus and P.E., * DVT = blood clot primarily formed deep in the lower-leg or thigh. Approx.. 1 per 1,000 people are affected which results in hospitalization of 5-7 days for therapy. Most patients (50%) are asymptomatic until the clot alters circulation such as a PE. Those that have symptoms are non specific making it difficult for early detection. * Pulmonary Embolism is a blood clot that becomes dislodged and enters the pulmonary (lung) circulation often resulting in severe consequences. It is a complication of DVT as PE is detected in about 50% of patients with documented DVT. It has an annual incidence of 23-69 per 100,000 individuals. Massive PE accounts for 10% of all hospital deaths or 200,000 per year. The mortality rate of untreated PE is about 30%, or 8-10 % if treated. 80% of patients who die from PE do so within the first 2 hours of symptom onset * D-Dimer can be useful in ruling-out DVT and PE due to its negative predictive value. D-Dimer can reduce the cost and time involved in evaluating patients for DVT and PE. Understand that D-Dimer cannot rule -in the diagnosis for DVT and PE because so many different states can ca