静脉血栓栓塞症危险因素PPT课件2.ppt

* There is a very strong association between PE and DVT: 90% of pulmonary emboli are as the result of DVT.3 A recent study showed that 82% of 患者 with acute PE had detectable DVT at the time PE was diagnosed.2 Silent PE occurs in more than 50% of 患者 with symptomatic proximal DVT.1 As the venous clot in the leg grows, it extends along the vein.4 DVT can develop into a chronic condition in which damage to the valves in the veins results in swelling of the leg, pain and venous hypertension (known as PTS). Parts of the clot can also detach, traveling in the blood to block vessels in the lungs, subsequently causing PE.4 If less than 50% of the pulmonary circulation is blocked, symptoms are generally limited to shortness of breath or are absent altogether. Very large emboli, however, can cause massive blockage of the pulmonary circulation and rapidly lead to death. 1. Pesavento R, Lusiani L, Visona A, Bonanane A, Zanco P, Perissinotto et al. Prevalenza di embolia polmonare clinicamente silente nella trombosi venosa profonda degli arti inferiori. Minerva Cardioangiologica. 1997 Jul-Aug;45(7-8):369–375 2. Girard P, Musset D, Parent F, Maitre S, Phlippoteau C, Simmonneau G. High prevalence of detectable deep venous thrombosis in 患者 with acute pulmonary embolism. Chest. 1999 Oct;116(4):903–908 3. Perrier A, Bounameaux H, Morabia A, de Moerloose P, Slosman D, Didier D, Unger P-F, Junod A. Diagnosis of pulmonary embolism by a decision analysis-based strategy including clinical probability, D-dimer levels, and ultrasonography: a management study. Arch Intern Med. 1996 Mar 11;156(5):531–536 4. Alpert JS, Dalen JE. Epidemiology and natural history of venous thromboembolism. Prog Cardiovasc Dis. 1994 May-Jun;36(6):417–422 美国每年至少2百万新发VTE，其中1/10的患者死亡 * Figure 1. Results of Trials of Prophylaxis for Venous Thromboembolism in High-Risk Hospitalized Patients. In three randomized, double-blind trials, enoxaparin, dalteparin, or fondaparinux was compared with placebo for the preve