内科病人静脉血栓栓塞高危者的识别与处理PPT.ppt

结论 VTE 在内科病人里很常见 使用抗凝剂预防有效 内科病人中LMWHs(如速碧林) 比 UFH 安全 在VTE高危患者中，抗凝剂预防使用不广泛 Discussion points Duration of prophylaxis Renal insufficiency Lower bleeding rates than surgery Advanced concomitant diseases High risk of death and complications Concomitant diseases increasing risk of haemorrhage Concomitant use of antiplatelet drugs 谢谢! * * * As shown on the figure, the incidence of PE and/or fatal PE increased over time in Japan (28,29) and Hong Kong (3,27). * * 2 Compared with surgical populations, far fewer studies have reported on the frequency of VTE in medical patients. However, those figures that are available suggest a moderate risk of deep vein thrombosis (DVT) in general medical patients in the absence of prophylaxis [8,9] according to the risk categories (low, moderate, high) defined by Salzman and Hirsh for surgical patients [10], with much higher rates in specific groups, as seen on this slide [7-9,11-14]. A recent study reported that up to one in 20 hospitalized medical patients with multiple problems and severe immobility may suffer fatal PE [15]. It should be noted, however, that the figures for VTE rates following myocardial infarction (MI) shown on the slide are based on studies conducted in the 1970s; with modern management practices with extensive use of thrombolytics, unfractionated heparin (UFH), low-molecular-weight heparin (LMWH) and antiplatelet agents, the incidence may now be lower. * * Limited number of studies and small in size * Different methods used for DVT diagnosis/outcome definition * Heterogeneity of the population studied * * * * * * * * 内科病人静脉血栓栓塞高危者的 识别与处理 VTE: 第3位最常见的血管疾病 1. Gillum RF. Am Heart. 1987;114:1262-1264. 2. Anderson et al. Arch Intern Med. 1991;151:933-938. 3. Silverstein et al. Arch Intern Med. 1998;158:585-593. “实际上等于卒中的发生率3 单纯DVT PE 伴有或不伴 DVT 年发生率 高达 69/100,0003 高达 145/100,0001,2 *北欧报导DVT/PE在普通人群中每年发病率为1.6-1.8‰.。 *美国研究每年60万人患PE, 其中6万人死亡。 我们对VTE的认识（误区） VTE在西方（高加素人）发生率高，但在亚洲人群里发病率不高； VTE在中国发生率低； VTE在外科，肿瘤科