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Guideline
静脉血栓栓塞症   VENOUS THROMBOEMBOLISM - MANAGEMENT
静脉血栓栓塞症(VTE)是一组血栓栓塞性疾病,包括深静脉血栓形成(DVT,血液在深静脉内凝结引起的静脉回流障碍,多发生于下肢)和肺血栓栓塞症(PTE,来自静脉系统或右心的血栓脱落,阻塞肺动脉或其分支引起的肺动脉栓塞)。
肺栓塞(PE):各种栓子阻塞肺动脉的一组疾病或临床综合征的总称,包括肺血栓栓塞症(PTE)、脂肪栓塞综合征、羊水栓塞、空气栓塞、肿瘤栓塞和细菌栓塞等。
肺血栓栓塞症(PTE):为肺栓塞的最常见类型,通常所称肺栓塞即指肺血栓栓塞症。引起肺血栓栓塞症的血栓主要来源于深静脉血栓形成,肺血栓栓塞症常为深静脉血栓形成的并发症。

静脉血栓形成的发生率因年龄增长、体重指数(BMI)增加和吸烟等因素而上升。
<80岁的男性人群中10.7%罹患本病,80岁人群的发病率是30岁人群的30余倍。
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医药新闻
2016年11月
2016年10月份共批准药品上市申请22件。其中,国产化学药品14件,生物制品2件;进口化学药品2件,生物制品4件。
2016年10月, Elvira Manzano
2016 ESC大会上的REVERSE II研究数据显示:一项新的临床决策规则有助于临床医生确定初发无诱因静脉血栓栓塞(VTE)女性停止抗凝治疗的时机。
2016年1月
根据药品不良反应评估结果,为进一步保障公众用药安全,国家食品药品监督管理总局决定对血塞通注射剂和血栓通注射剂说明书【不良反应】、【禁忌】和【注意事项】项进行修订。
2015年5月, Dr. Maria Katrina Florcruz
美国密歇根州安阿伯市密歇根大学医学院的专家提醒临床医生注意:PICC(经外周静脉穿刺中心静脉置管术)导管有可能增加住院患者发生上肢深静脉血栓形成(DVT)的风险。
2015年3月, Elvira Manzano
美国食品及药物管理局(FDA)批准Xa因子(一种新型凝血因子)抑制剂依杜沙班(edoxaban)(Savaysa®,日本第一三共株式会社)用于非瓣膜性房颤(AF)患者,以降低此类患者卒中及其他全身性栓塞事件的发生风险。
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药物信息

拜瑞妥 Xarelto  [  拜耳医药保健 Bayer HealthCare   ]  -  利伐沙班 rivaroxaban
适应症: 用于下列情况的成人患者:择期髋关节或膝关节置换手术者预防VTE;DVT治疗及降低急性DVT后的复发和PE风险;具有1种以上危险因素的非瓣膜性房颤患者降低卒中和全身性栓塞的风险。
MIMS药理分类 抗凝血、抗血小板和纤维蛋白溶解剂 Anticoagulants, Antiplatelets & Fibrinolytics (Thrombolytics)  
Xarelto filcotab 10 mgf62a8723-c1fb-4262-8510-a4ba00a1e260.GIF
爱通立 Actilyse  [ 勃林格殷格翰 Boehringer Ingelheim ]   [ 国药集团药业股份有限公司 CNCM Pharm 阿替普酶 Alteplase
适应症: 急性心梗、血流不稳定的急性大面积肺栓塞、急性缺血性脑卒中的溶栓治疗。
MIMS药理分类 抗凝血、抗血小板和纤维蛋白溶解剂 Anticoagulants, Antiplatelets & Fibrinolytics (Thrombolytics)  
安卓 arixtra  [ 葛兰素史克 GlaxoSmithKline 磺达肝癸钠 Fondaparinux sodium
适应症: 用于进行下肢重大骨科手术患者预防静脉血栓栓塞事件的发生;无指征进行紧急(<120分钟)PCI的不稳定性心绞痛或非ST段抬高心梗的治疗;使用溶栓或初始不接受其它形式再灌注治疗的ST段抬高心梗治疗。
MIMS药理分类 抗凝血、抗血小板和纤维蛋白溶解剂 Anticoagulants, Antiplatelets & Fibrinolytics (Thrombolytics)  
克赛 Clexane  [ 赛诺菲 sanofi 依诺肝素 Enoxaparin sodium
适应症: 参见【用法用量】。
MIMS药理分类 抗凝血、抗血小板和纤维蛋白溶解剂 Anticoagulants, Antiplatelets & Fibrinolytics (Thrombolytics)  
多巴酚丁胺-上海一生化 Dobuamine-Shanghai No.1 Biochem  [ 上海一生化 Shanghai No.1 Biochem 多巴酚丁胺 Dobutamine
适应症: 由器质性心脏病或心外科手术引起心肌收缩力下降而导致的急性心功能不全或心源性休克的治疗中,对心肌进行短期的正性肌力支持。
MIMS药理分类 心功能不全和心律失常用药 Cardiac Drugs  
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参考文献
  1. 内科住院患者静脉血栓栓塞症预防的中国专家建议,中华医学会老年医学分会,中华医学会呼吸病学分会 -中华结核和呼吸杂志,2009年1月,第32卷第1期;3-8页
  2. 华法林抗凝治疗的中国专家共识,中华医学会心血管病学分会,中国老年学学会心脑血管壁专业委员会-中华内科杂志,2013年1月,第52卷第1期,76-82页
  3. 实用内科学(第14版) - 人民卫生出版社,2013年(主编:陈灏珠,林果为,王吉耀)。
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  5. 心血管内科诊疗精要 - 中南大学出版社, 2011(主编:赵水平、李江)
  6. 急性肺血栓栓塞症诊断治疗中国专家共识,中华医学会心血管病学分会肺血管病学组,中国医师协会心血管内科医师分会 - 中华内科杂志,2010年1月,第49卷第1期,74-81
  7. 深静脉血栓形成的诊断和治疗指南(第2版),中华医学会外科学分会血管外科学组 -中华外科杂志,2012年7月,第50卷第07期;611-614页
  8. 静脉血栓栓塞预防和治疗的中国专家共识,心血管疾病防治中国专家共识(2006荟萃版)-人民卫生出版社(主编:胡大一)
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  14. Institute for Clinical Systems Improvement (ICSI). Venous thromboembolism diagnosis and treatment. https://www.icsi.org/guidelines__more/catalog_guidelines_and_more/catalog_guidelines/catalog_cardiovascular_guidelines/vte_treatment/. Jan 2012. Accessed 08 Feb 2012
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