DVT诊断治疗指南 .ppt

2008ESC急性肺栓塞溶栓治疗禁忌证 绝对禁忌证 任何时间出血性或不明原因的脑卒中 6个月内缺血性脑卒中 中枢神经系统损伤或肿瘤 3周内大创伤、外科手术、头部损伤 近一月内胃肠道出血 已知的活动性出血 相对禁忌证 6个月内短暂性脑缺血发作 口服抗凝药 妊娠或分娩1周内 不能压迫的血管穿刺 创伤性心肺复苏 难治性高血压(收缩压180 mmHg) 晚期肝病 感染性心内膜炎 活动性消化性溃疡 A Contraindications to thrombolysis that are considered absolute, e.g. in acute myocardial infarction, might become relative in a patient with immediately life-threatening high-risk PE. * ppt课件 国内专家共识溶栓禁忌 绝对禁忌：(1)活动性内出血；(2)近期自发性颅内出血。 相对禁忌：(1)2周内的大手术、分娩、器官活检或不能压迫止血部位的血管穿刺；(2)2个月内的缺血性中风；(3)10天内的胃肠道出血；(4)15天内的严重创伤；(5)1个月内的神经外科或眼科手术；(6)难于控制的重度高血压(收缩压 180 mm Hg，舒张压 110 mm Hg)；(7)近期曾行心肺复苏；(8)血小板计数低于100×109/L；(9)妊娠；(10)细菌性心内膜炎；(11)严重肝肾功能不全；(12)糖尿病出血性视网膜病变；(13)出血性疾病；(14)动脉瘤；(15)左心房血栓；(16)年龄75岁。 * ppt课件 经皮静脉栓子切除 ADVT患者不建议单独经皮栓子切除 (Grade 2C). * ppt课件 ADVT手术静脉栓子切除 假如医疗条件合适,在有选择的iliofemoral ADVT患者 (eg, iliofemoral DVT, symptoms for7 days, good functional status, life expectancy of1 year) 建议手术静脉栓子切除治疗,或可减轻急性症状及栓塞后残疾 (Grade 2B) 假如有高出血风险,建议CDT而不是手术静脉栓子切除术(Grade 2C). 静脉栓子切除的ADVT患者,建议与未行静脉栓子切除患者给予一样的抗凝疗程和治疗强度 (Grade1c) * ppt课件 腔静脉滤器初始治疗ＤＶＴ DVT患者除了抗凝,不常规使用腔静脉滤器 (Grade 1A). 假如由于出血风险近端ADVT抗凝治疗不可能,推荐植入下腔静脉 (IVC)滤器(Grade 1C). 假如ADVT患者植入IVC滤器,推荐出血风险去除后予后续抗凝治疗 (Grade 1C). * ppt课件 滤器置入可预防VTE复发? What Are the Incidences of Pulmonary Embolism and DVT Recurrences after Placement of Vena Cava Filters? An observational cohort study used administrativedata to assess patients with VTE who did and did not receive vena cava ?lters during a 5-year period . After adjustment for risk factors associated with recurrent VTE ?lter placement did not reduce pulmonary embolism but was associated with a 2-fold increase in the relative hazard of subsequent DVT among patients with initial pulmonary embolism. Overall, there is insuf?cient evidence to make recommendations in this area. Management of Venous Thromboembolism: A Clinical Practice Guideline from the American College of Physicians and the American Academy of Family Physicians, Ann Intern Med. 2007;146:204-210 * ppt课件 PTS及静脉溃疡 血栓性浅静脉炎 UEDVT 关于制动