DVT诊断治疗指南.pptVIP

* ACCP,Thromboembolic Disease Antithrombotic Therapy for Venous Thromboembolic Disease, Chest 2004;126;401S-428S ACCP,Thromboembolic Disease Antithrombotic Therapy for Venous Thromboembolic Disease, Chest 2008;133;454S-545S 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. Guidelines on the diagnosis and management of acute pulmonary embolism, European Heart Journal (2008) 29, 2276–2315 Prevention of Venous Thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) .Chest，2008，133(suppl 6) 中华内科杂志,中国急性肺血栓栓塞症诊断治疗专家共识2009 中国医师协会循证医学专业委员会,静脉血栓栓塞预防和治疗的专家共识2006 中华医学会外科学分会血管外科学组,深静脉血栓形成的诊断和治疗指南2007 中华医学会重症医学分会, ICU病人深静脉血栓形成预防指南2009 * * /10/29 * * 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。 * 经皮静脉栓子切除 ADVT患者不建议单独经皮栓子切除 (Grade 2C). * 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) * 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). * 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 w