Author/Editor		Salobir, Barbara
Title		Nadaljevanje zdravljenja po venski trombozi
Translated title		Secondary prophylaxis of venous thrombosis
Type		članek
Source		Med Razgl
Vol. and No.		Letnik 39, št. Suppl 2
Publication year		2000
Volume		str. 37-42
Language		slo
Abstract		After initial treatment of venous thrombosis and/or pulmonary embolism, secondary prophylaxis is usually prescribed to prevent recurrent thrombotic events. The most prevalent choice is with oral anticoagulants with coumarins and, in rare cases, by standard or low molecular weight heparins. The duration of secondary prophylaxis depends on the risk of recurrent venous thrombosis and/or pulmonary embolism without anticoagulants and on the risk of major bleeding during anticoagulation. The risk of recurrent venous thrombosis and/or pulmonary embolism is low in patients with calf vein thrombosis or those with a temporary triggering cause, intermediate in patients with idiopathic venous thrombosis and/or pulmonary embolism or heterozygous activated protein C resistance and high in patients with cancer, with the antiphospholipid syndrome and in most cases of inherited thrombophilia. After the first event, patients at low risk should be treated for 3 months, patients with intermediate risk for 6 months and patients with high risk indefinitely. After the second event, patients at low risk should be treated for 1 year and those at intermediate risk for 1 year to lifetime. After the third event, all patients should be treated indefinitely. In the case of high risk of major haemorrhage or high risk of death during the first event due to a massive pulmonary embolism, the recommended duration of therapy can be individually shortened or prolonged.
Summary		Po začetnem zdravljenju venske tromboze in/ali pljučne embolije je indicirano nadaljevanje antikoagulacijskega zdravljenja zaradi preprečevanja ponovnih tromboemboličnih dogodkov. V večini primerov bolnikom dajemo kumarine, izjemoma pa standardni ali nizkomolekularni heparin. Trajanje antikoagulacijskega zdravljenja je odvisno od tveganja za ponovitev venske tromboze in/ali pljučne embolije brez antikoagulacijskega zdravljenja in tveganja za velike krvavitve med antikoagulacijskim zdravljenjem. Tveganje za ponovitev venske tromboze in/ali pljučne embolije je majhno pri bolnikih z golensko vensko trombozo in pri bolnikih s prehodnim sprožilnim dejavnikom, srednje pri idiopatski venski trombozi in/ali pljučni emboliji in heterozigotih za neodzivnost na aktivirani protein C ter veliko pri bolnikih z rakom, antifosfolipidnim sindromom in pri nekaterih oblikah prirojene trombofilije. Po prvi venski trombozi in/ali pljučni emboliji predpišemo bolnikom z majhnim tveganjem za ponovitev bolezni 3-mesečno zdravljenje, bolnikom s srednje velikim tveganjem 6 mesečno zdravljenje in bolnikom z zelo velikim tveganjem trajno zdravljenje. Po prvi ponovitvi venske tromboze in/ali pljučne embolije predpišemo bolnikom z majhnim tveganjem enoletno zdravljenje, pri bolnikih s srednje velikim tveganjem se odločimo individualno za enoletno ali trajno zdravljenje. Po drugi ponovitvi vsem bolnikom predpišemo trajno zdravljenje. Individualno lahko priporočeno trajanje skrajšamo pri bolnikih, zelo ogroženih za krvavitve, ali podaljšamo pri bolnikih, ki so bili ob akutnem dogodku vitalno ogroženi zaradi masivne pljučne embolije.
Descriptors		THROMBOPHLEBITIS RECURRENCE HEPARIN WARFARIN HEMORRHAGE RISK FACTORS