深静脉血栓推荐意见.doc

Treatment of Acute Deep Vein Thrombosis (DVT)
Initial Anticoagulation of Acute DVT of the Leg
In patients with acute DVT of the leg treated with vitamin-K antagonist (VKA) therapy, the expert panel recommends initial treatment with parenteral anticoagulation (low-molecular-weight heparin [LMWH], fondaparinux, intravenous[IV] unfractionated heparin [UFH], or subcutaneous [SC] UFH) over no such initial treatment (Grade 1B).
Whether to Treat with Parenteral Anticoagulation While Awaiting the Results of Diagnostic Work-up for VenousThromboembolism (VTE)
In patients with a high clinical suspicion of acute VTE, the expert panel suggests treatment with parenteral anticoagulants compared with no treatment while awaiting the results of diagnostic tests (Grade 2C).
In patients with an intermediate clinical suspicion of acute VTE, the expert panel suggests treatment with parenteral anticoagulants compared with no treatment if the results of diagnostic tests are expected to be delayed for more than 4 h (Grade 2C).
In patients with a low clinical suspicion of acute VTE, the expert panel suggests not treating with parenteral anticoagulants while awaiting the results of diagnostic tests, provided test results are expected within 24 h (Grade 2C).
Whether and How to Prescribe Anticoagulants to Patients with Isolated Distal DVT
In patients with acute isolated distal DVT of the leg and without severe symptoms or risk factors for extension, the expert panel suggests serial imaging of the deep veins for 2 weeks over initial anticoagulation (Grade 2C).
In patients with acute isolated distal DVT of the leg and severe symptoms or risk factors for extension (see text), the expert panel suggests initial anticoagulation over serial imaging of the deep veins (Grade 2C).
Remarks: Patients at high risk for bleeding are more likely to benefit from serial imaging. Patients who place a high value on avoiding the inconvenience of repeat imaging and a low value on the inconvenience of treat