Chinese Medical Sciences Journal ›› 2018, Vol. 33 ›› Issue (2): 120-126.doi: 10.24920/21805

• 综述 • 上一篇    下一篇

合并冠心病的静脉血栓栓塞症患者的抗栓治疗

周梦馨,孙蕊,陈跃鑫()   

  1. 中国医学科学院 北京协和医学院,北京协和医院 血管外科, 北京 100730 中国
  • 收稿日期:2017-08-08 出版日期:2018-06-30 发布日期:2018-06-13
  • 通讯作者: 陈跃鑫 E-mail:cyuexin@163.com

A Literature Review of Antithrombotic Therapy for Patients of Venous Thromboembolic Events with Comorbidity of Coronary Heart Disease

Zhou Mengxin,Sun Rui,Chen Yuexin()   

  1. Department of Vascular Surgery, Peking Union Medical College Hospital,Chinese Medical Sciences Academy & Peking Union Medical College,Beijing 100730, China
  • Received:2017-08-08 Published:2018-06-30 Online:2018-06-13
  • Contact: Chen Yuexin E-mail:cyuexin@163.com

摘要:

合并静脉血栓栓塞症(VTE)和冠心病(CHD)的患者在临床上并不少见。治疗这类患者的主要挑战是针对VTE和CHD的抗栓治疗原则不尽相同,如果联合用药则增加出血风险。因此应根据患者疾病情况评估疗效和出血风险,以选用最佳抗栓治疗方案。本文讨论了同时合并VTE和CHD的患者在不同情况下,如何根据病情和出血风险,选择相应的抗栓治疗,包括联合抗凝药物治疗、双联抗血小板治疗、三联抗栓治疗、溶栓治疗及后续长期治疗,以期为这类患者制定规范的、安全而有效的治疗方案提供参考。同时,本文还就新型口服抗凝药的应用及出血风险的评估方法进行了展望。

关键词: 静脉血栓栓塞症, 冠心病, 抗栓治疗, 联合治疗

Abstract:

Patients with venous thromboembolism (VTE) and concurrent coronary heart disease (CHD) are not rare in clinic. The main challenge in the treatment for these patients is that the antithrombotic therapies for VTE and CHD are different from each other, but the combination of the two therapeutic strategies would increase the risk of bleeding. There is a need to optimize the antithrombotic therapeutic scheme on the basis of individual conditional, in order to balance the therapeutic effects and the bleeding risk. This article discussed the appropriate antithrombotic therapy when balancing the effectiveness and the risk in different circumstance of concurrence of VTE and CHD, such as combining anticoagulation therapy, dual antiplatelet therapy (DAPT), triple antithrombotic therapy (TAT), thrombolytic therapy and extending therapy, in order to provide safe, standard and effective therapeutic schemes for the clinical management of these patients. In the meantime, this article also provides perspectives regarding the application of novel non-vitamin K anticoagulants (NOACs) and the assessment tools of bleeding risk.

Key words: venous thromboembolism, coronary heart disease, antithrombotic therapy, combination therapy

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