2010 ICSI保健指南：静脉血栓栓塞症的诊断与治疗
Health Care Guideline:Venous Thromboembolism Diagnosis and Treatment
2010-02-01
Clinicians Highlights and Recommendations:A clinical pretest probability assessment should be completed in patients with suspected venous thromboembolism.D-dimer can be used as a negative predictor to eliminate need for further testing.Confirm diagnosis of deep vein thrombosis (DVT) with imaging study, preferably duplex ultrasound (with compression).In patients with a high clinical pretest probability for pulmonary embolism (PE), begin anticoagulation without delay.Computed tomographic angiography combined with clinical pretest probability scoring and D-dimer testing has the predictive value to safely diagnose or rule out pulmonary embolism in patients. Additional diagnostic testing is necessary only when clinical symptoms persist or progress.Achieve rapid effective anticoagulation with low-molecular-weight heparin (LMWH)/fondaparinux.In patients with acute VTE, heparin (UFH, LMWH or fondaparinux) should be given for at least five days and until the INR > 2.0 for two consecutive days.Arrange for home therapy in appropriate patients.Graduated compression stockings may help prevent post-phlebotic syndrome. All patients should be assessed for the need for graduated compression stockings (not Teds).Patient to be treated three to six months for acute thrombosis followed by re-evaluation of ongoing risks to determine the need for ongoing anticoagulation therapy to prevent recurrent events.
