肾病综合征并发VTE的防治.ppt

利伐沙班治疗PE的对照研究 N Engl J Med 2012;366:1287-97 利伐沙班 预防血栓疗效不劣于标准治疗 减少大出血并发症（1.1% vs2.2% ) Cumulative event rate(%) VTE溶栓指征和方法 PE 急性大面积PE（出现休克与低血压者）且无溶栓禁忌 外周静脉给药而非经导管给药 2h给药法：r-tPA 50mg；链激酶150万u 持续静脉滴注2h 急性广泛近端DVT 症状14d,一般情况良好，预计生存期?1y 经导管局部或外周静脉给药 肾静脉血栓 急性双侧、伴ARF、伴腔静脉血栓 IMN预防性抗凝KIDIGO指南 We suggest that patients with IMN and severe nephrotic syndrome be considered for prophylactic anticoagulant therapy. (2C) There have been no RCTs of prophylactic anticoagulation in IMN with nephrotic syndrome Alb2.0-2.5g/dL、proteinuria10g/d、BMI 35kg/m2，prior history of thromboembolism、prolonged immobiliz