周圍血管疾病急性深靜脈血栓課件

PeripheralVascularDisease

(周圍血管疾病)PeripheralVascularDiseasePeripheralVascularDiseaseDiseasesofbloodvesselsoutsidetheheartandbrainDisordersoftheveinsPeripheralarterialdisease(PAD)

PeripheralVascularDiseaseAcuteDeepVenousThrombosis急性深靜脈血栓AcuteDeepVenousThrombosisVenousThromboembolism(VTE)Acutedeepvenousthrombosis(DVT)Pulmonaryembolism(PE)Post-thromboticsyndromeAcuteDeepVenousThrombosisRiskFactorsforAcuteDeepVenousThrombosis(DVT)andPulmonaryEmbolism(PE)

AcuteDeepVenousThrombosisRiskFactorsforAcuteDeepVenousThrombosis(DVT)andPulmonaryEmbolism(PE)PrimaryHypercoagulableStatesPregnancyOralContraceptivesandHormonalTherapy…AcuteDeepVenousThrombosisSignsandsymptomsSymptomsAbsenceofsymptomsMassiveswellingCalfpain,edema,erythema,feverCyanosiswithimpendingvenousgangrene(phlegmasiaceruleadolens，股青腫)SignsProminentsuperficialveinsHypertoniaandtendernessofcalfHomans’sign(painwithpassivedorsiflexionofthefoot)AcuteDeepVenousThrombosisVascularLabVenography(“goldstandard〞,historically)DuplexUltrasonographyComputedtomographyvenography(CTV)D-DimerAssaysAcuteDeepVenousThrombosisAscendingvenographyMay-ThurnersyndromeAcuteDeepVenousThrombosisDuplexUltrasonographySensitivity：97%Specificity：94%,Positivepredictivevalues：97%Negativepredictivevalues：98%,AcuteDeepVenousThrombosisDuplexUltrasonographyNormalThrombosedpoplitealveinAcuteDeepVenousThrombosisComputedtomographyvenography(CTV)AcuteDeepVenousThrombosisD-DimerAssaysElevatedD-dimervaluesareassociatedwith：Thrombosis〔sensitivity96.8%〕DICMalignancyPostoperativestatesPreeclampsiaInfectionRecenttraumaAcuteDeepVenousThrombosisPreventionofVenousThromboembolismLow-molecular-weightheparin(LMWH)IntermittentpneumaticlegcompressionGraduated-CompressionStockingsOralAnticoagulantsAcuteDeepVenousThrombosisTreatmentAnticoagulantTherapyThrombolytictreatmentInpatientswithDVT,werecommendagainsttheroutineuseofIVthrombolytictreatment(Grade1A)IVCfilterplacementFormostpatientswithDVT,werecommendagainst

theroutineuseofavenacavafilterinadditiontoanticoagulants(Grade1A)EighthACCPConferenceonAntithromboticandThrombolyticTherapy，2021AcuteDeepVenousThrombosisAnticoagulantTherapyforVTEObjectivesoftreatmentinpatientswithVTEare:

TopreventdeathfromPETopreventrecurrentVTETopreventthepost-thromboticsyndromeAcuteDeepVenousThrombosisAnticoagulantTherapyforVTEAnticoagulantdrugsHeparin(100U/kgbodyweight,SC,q12h)LMWH(0.1ml/10kgbodyweight,SC,q12h)Warfarin(KeepINR2.0-3.0)AcuteDeepVenousThrombosisContraindicationsofAnticoagulantTherapyPatientswhohaveundergonesurgerywithintheprevious2weeksPatientswithaprevioushistoryofpepticulcerdiseaseorgastrointestinalorgenitourinarybleeding.Patientswithrecentstroke(i.e.,thromboticstrokewithin2weekspreviously)Patientswithaplateletcount<150×109/LPatientswithmiscellaneousreasonsforahighrisk