Kev tiv thaiv ntawm thrombus kis theem

Tsis muaj qhov tsis ntseeg tias kev txhim kho cov tshuaj tiv thaiv coagulants tau ncaj qha rau kev kho DVT.Anticoagulant therapy tuaj yeem tiv thaiv qhov tshwm sim ntawm thrombus, inhibit qhov kis ntawm thrombus, pab txhawb lub autolysis ntawm thrombus thiab recanalization ntawm lumen, alleviate cov tsos mob, thiab txo qhov tshwm sim thiab tuag ntawm pulmonary embolism.Tam sim no, cov tshuaj anticoagulant feem ntau suav nrog heparin, qis molecular hnyav heparin, warfarin, rivaroxaban thiab dabigatran.Txhua yam ntawm cov tshuaj no muaj nws tus kheej zoo thiab qhov tsis zoo.Piv nrog rau cov heparin unfractionated, tsis tshua muaj molecular hnyav heparin subcutaneously los yog intravenously tuaj yeem txo qhov kev tuag.Ntawm cov tshuaj anticoagulants ntawm qhov ncauj, warfarin yog dav siv vim nws cov nqi qis, cov nyhuv anticoagulant tseeb nyob rau hauv cov kev kho mob zoo (yuav tsum tau tus qauv thoob ntiaj teb sib piv ntawm 2 thiab 3).Txawm li cas los xij, vim tias warfarin cuam tshuam zoo heev los ntawm cov khoom noj, nws yog ib qho yooj yim kom muaj teeb meem xws li tsis txaus anticoagulation thiab los ntshav, thiab nws yog ib qho tsim nyog yuav tau saib xyuas cov coagulation ua haujlwm tsis tu ncua.Nyob rau hauv xyoo tas los no, ntau tus tshiab anticoagulants tau tshwm sim hauv txaj, xws li rivaroxaban, dabigatran, apixaban, thiab lwm yam. cov nyhuv anticoagulant yog qhov tseeb, cov teeb meem los ntshav tau txo qis, thiab tsis tas yuav rov kuaj xyuas cov haujlwm coagulation.

Tam sim no, qee cov kws tshawb fawb qhia tias kev kho tshuaj tuaj yeem muab faib ua ob theem raws li lub sijhawm faib 3 lub hlis: thawj theem hu ua thawj theem kev kho mob.Nws yog tsuas yog nqa tawm nyob rau hauv 3 lub hlis tom qab pib pib ntawm dvt3, thiab theem thib ob yog hu ua qhov kev tiv thaiv rov qab los ntawm kev tiv thaiv, uas yog nqa tawm 3 lub hlis tom qab thawj theem ntawm kev kho mob.Accp9 cov lus qhia thawj zaug pom zoo cov tshuaj tiv thaiv qhov ncauj tshiab.Hauv 10th tsab ntawm American College of Chest Physicians (ACCP) cov lus qhia, qhov sib txawv loj tshaj yav dhau los yog cov tshuaj tiv thaiv kab mob hauv qhov ncauj tshiab (noac), xws li factor Xa inhibitors (rivaroxaban, fondaparinux sodium, thiab lwm yam) thiab IIA inhibitors ( dabigatran, thiab lwm yam) yog siv los ua thawj qhov kev xaiv rau kev kho mob ntawm VTE.Anticoagulant therapy muaj cov txiaj ntsig zoo, txo qis cov teeb meem los ntshav, thiab tsis tas yuav rov kuaj dua ntawm coagulation muaj nuj nqi.Nws tau raug txhawb ntxiv rau cov neeg mob zoo tib yam.Cov tshuaj anticoagulants tshiab feem ntau tuaj yeem zam kev rov tshwm sim ntawm DVT hauv 80% ~ 92%.

Qhov kev txwv ntawm kev kho anticoagulant ib leeg yog tias txawm hais tias txoj kev kho anticoagulant feem ntau siv los txo cov thrombus rov qab thiab tiv thaiv venous valve muaj nuj nqi, nws tsis tuaj yeem yaj thrombus sai.Kev tshem tawm ntawm tus kheej ntawm thrombus tsis tshua pom nyob rau hauv cov neeg mob uas muaj iliofemoral vein thrombosis, thiab cov thrombus seem tuaj yeem ua rau venous valve puas thiab cov dej ntws tawm, uas yog vim li cas rau qhov tshwm sim siab ntawm postthrombosis syndrome (PTS).Kev soj ntsuam kev tshawb fawb txog qhov tshwm sim ntawm PTS tom qab DVT anticoagulant kho tau pom tias qhov tshwm sim ntawm PTS yog li 20% ~ 50%, qhov tshwm sim ntawm venous rwj ntawm qis qis yog 5% ~ 10%, thiab qhov tshwm sim ntawm venous claudication yog 40%. tom qab 5 xyoos.Kwv yees li ntawm 15% ntawm cov neeg mob muaj kev txav tsis zoo, thiab lub neej zoo ntawm 100% ntawm cov neeg mob tau txo qis rau ntau qib.