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1、下肢急性深靜脈血栓（DVT卜初始抗凝治療AcuteDeepVenousThrombosis(DVT)oftheLeg:InitialAnticoagulantTherapyTheACCP?s9theditionoftheirclinicalpracticeguidelinesforpreventionandtreatmentofvenousthromboembolism(VTE)werepublishedinFebruary2012,andwe?resummarizingthe801?pagelongdocumentpi
2、ecebypiece.(Seealsothe)Herewereviewthesectionontheinitialtreatmentofacutedeepvenousthrombosis(DVT)ofthelegwithantithrombotic/anticoagulanttherapy.DVTHPE:OverlappingDiseaseswithSubtleDifferencesAlthoughdeepvenousthrombosisprecedesandoftencoexistswithpulmonaryembol
3、ism,andbotharetreatedwithanticoagulation,thetwoconditionsarenotinterchangeable.Still,theyhavehistoricallybeenconsideredso,forsomegoodreasons:■■■?MostpeoplewithsymptomaticDVTalsohavePE(eithersymptomaticor"silent〃)?MostpeoplewithsymptomaticPEalsohaveDVT(withorwitho
4、utsymptoms).Clinicaltrials"lumping"patientswithDVTalone,DVTandPE,orPEalonehavehadsimilaroutcomesforefficacyandsafetyofanticoagulationtreatment.TheriskofpulmonaryembolismafterproximalDVT(butnotdistal)andafterafirstPEappeartobesimilar.However,therearesomesubtlebutc
5、riticallyimportantdifferencesbetweenthetwoconditions:■?TheriskofdeathwithinonemonthisfarhigherinpeoplepresentingwithPE,comparedtoDVT.RecurreneeafteraPEismorelikelytobeaPEthanaDVT(i.e.zmoredangerous).InpatientswithaPE,about60%ofrecurrenteventsarePEs,whileinpatient
6、swithaninitialDVT(withoutPE),only20%ofrecurrenteventswillbePEs.TheseincreasedriskstendtojustifyamoreaggressivetreatmentapproachforpatientswhopresentwithPE(Iongerormoreintenseanticoagulation,IVCfilters,etc.),comparedtoisolatedDVT.PeoplewithProximalLegDVTShouldInit
7、iallyReceive5+DaysHeparinorFondaparinux(andWarfarin)■?PatientswithacuteproximallegDVTwhowillreceivewarfarinshouldinitiallybetreatedwithheparin(lowmolecularweightorunfractionated,subcutaneousorintravenous)orfondaparinux(GradeIB)*?Tworandomizedtrialsshowedthebenefi
8、tofthisapproachovernoheparin.Heparinorfondaparinux(parenteralanticoagulation)shouldbestartedthesamedayaswarfarin,andcontinuedforatleast5daysanduntiltheINRis2.0
