NEJM：血栓形成倾向检测流程和推荐意见

2017-10-05 杨中华脑血管病及重症文献导读

在临床上经常进行血栓形成倾向检测；哪些患者需要检测，如何解读这些结果尚不清楚。截止到目前尚未发表血栓形成倾向检测的指南。ACCP-9指南以及2016年静脉血栓栓塞（VTE）更新版并未对血栓形成倾向检测给出指导性建议，2013年美国血液学会对于存在短暂性重要危险因素的VTE患者不推荐进行血栓形成倾向检测。英国血液病学委员会遗传性血栓形成倾向临床指南认为“关于何种患者或家属需要进行检测，不可能给出确切

在临床上经常进行血栓形成倾向检测；哪些患者需要检测，如何解读这些结果尚不清楚。截止到目前尚未发表血栓形成倾向检测的指南。ACCP-9指南以及2016年静脉血栓栓塞（VTE）更新版并未对血栓形成倾向检测给出指导性建议，2013年美国血液学会对于存在短暂性重要危险因素的VTE患者不推荐进行血栓形成倾向检测。英国血液病学委员会遗传性血栓形成倾向临床指南认为“关于何种患者或家属需要进行检测，不可能给出确切的推荐意见”。

临床上很多医生不清楚什么样的患者需要检测，检测结果的解读也存在差异，所以来自波士顿的Jean M. Connors于2017年9月在NEJM上发表了综述《血栓形成倾向检测和静脉血栓形成》，现将部分内容摘录如下。

一、遗传性血栓形成倾向伴发VTE患者的临床特征

1.年轻（<50岁）的VTE，特别是弱危险因素（weak provoking factors）（外科小手术，使用口服抗凝剂或不能活动）或无原因VTE（unprovoked VTE）者

2.强（strong）VTE家族史（一级家族成员年轻时发病）

3.复发性VTE事件，特别是年轻人*

4.少见部位VTE如内脏或脑静脉?

备注：

*此时需要鉴别抗磷脂抗体综合征，没有遗传性

需要评价骨髓增值性肿瘤和发作性睡眠血红蛋白尿症

二、首次VTE血栓形成倾向检测筛选流程

备注：aPL-抗磷脂抗体，MPN-骨髓增生性肿瘤，PNH发作性睡眠血红蛋白尿症，FVL-Leiden V因子，PTG-凝血酶基因突变

三、血栓形成倾向检测推荐意见

1.VTE事件时不检测

解释：危险因素诱发VTE抗凝治疗结束时检测；对于无诱因VTE，如果打算终止抗凝治疗应于急性事件治疗后检测，检测结果可能会改变管理策略

2.抗凝治疗期间不检测

解释：VKA停用至少2周，DOAC停用至少2天（最好更久），UFH或LMWH停用>24h

3.强烈危险因素诱发VTE者不检测

解释：强烈危险因素指严重创伤，大手术，不活动，重病

4.可以考虑检测

解释：诱发因素较弱的年轻VTE者或VTE较强家族史或复发性VTE

5.理清检测目的

解释：理清检测目的以便制定将来VTE预防策略，指导家庭成员检测（特别是COC或女性家庭成员妊娠者），确定病因（特别是严重VTE，家庭成员中致死性VTE，或不常见部位VTE）；检测结果本身无法确定抗凝治疗的持续时间

备注：COC-复方口服避孕药，DOAC-直接口服抗凝剂，LMWH-低分子肝素，UFH-普通肝素，VKA-维生素K拮抗剂

原始出处：

Jean M. Connors.Thrombophilia Testing and Venous Thrombosis.N Engl J Med. 2017 Sep 21;377(12):1177-1187. doi: 10.1056/NEJMra1700365.

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2017-10-15 天涯183

非常好的文章.学习了

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2017-10-08 天涯183

非常好的文章.学习了

153 0
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2017-10-08 thlabcde

好资料学习了!

153 0
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2017-10-08 sunfeifeiyang

学习

136 0
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2017-10-07 大爰

学习了谢谢分享!!

154 0
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2017-10-07 lishizhe

#血栓形成倾向#

122 0
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2017-10-06 天涯183

非常好的文章.学习了

116 0
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2017-10-06 Y—xianghai

学习了新知识

123 0
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2017-10-05 清风拂面

谢谢分享.学习了

114 0

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