臨床外科68巻2号

2013年02月発行

特集 術後の血管系合併症―その診断と対策

術後の骨盤・下肢静脈血栓・閉塞―治療のコツ

著者： 岡本宏之¹

所属機関： ¹東京大学血管外科

ページ範囲：P.191 - P.193

【ポイント】

◆外科手術後，深部静脈血栓症と診断したら，持続性の出血がない限り直ちに抗凝固療法を開始する．

◆抗凝固療法開始前に，先天性の血栓性素因（プロテインSおよびC，ATⅢなど）をチェックする．

◆抗凝固療法と同時に弾性包帯などによる圧迫療法を開始し，血栓後遺症の発生予防と軽減に努める．

参考文献

1）Kearon C, Kahn SR, Agnelli G, et al：Antithrombotic therapy for venous thromboembolic disease. American college of chest physicians evidence-based clinical practice guidelines（8th edition）. Chest 133：502S-510S, 2008

2）Brandjes DP, Heijboer H, Buller HR, et al：Acenocoumarol and heparin compared with acenocoumarol alone in the initial treatment of proximal-vein thrombosis. N Engl J Med 327：1485-1489, 1992

3）Nicolaides AN, Fareed J, Kakkar AK, et al：Prevention and treatment of venous thromboembolism International Consensus Statement（Guidelines according to scientific evidence）. Int Angiol 25：101-161, 2006

4）Cruickshank MK, Levine MN, Hirsh J, et al：A standard heparin nomogram for the management of heparin therapy. Arch Intern Med 151：333-337, 1991

5）Hull RD, Raskob GE, Rosenbloom D, et al：Optimal therapeutic level of heparin therapy I patients with venous thrombosis. Arch Intern Med 152：1589-1595, 1992

6）Raschke RA, Reilly BM, Guidry JR, et al：The weightbased heparin dosing nomogram compared with a “standard care” nomogram：a randomized controlled trial. Ann Intern Med 119：874-881, 1993

Rutherford RB ed：Vascular Surgery 6th ed. Elsevier, Philadelphia, Saunders, 2005, pp 2157-2156

8）O'Sullivan EF：Duration of anticoagulant therapy in venous thrombo-embolism. Med J Aust 2：1104-1107, 1972

9）Schulman S, Lockner D, Juhlin-Dannfelt A：The duration of oral anticoagulation after deep vein thrombosis：a randomized study. Acta Med Scand 217：547-552, 1985

10）Brandjes DP, Buller HR, Heijboer H, et al：Randomized trial of effect of compression stocking in patients with symptomatic proximal-vein thrombosis. Lancet 349：759-762, 1997

11）Partsch H, Kaulich M, Mayer W：Immediate mobilization on acute vein thrombosis reduces post-thrombotic syndrome. Int Angiol 23：206-212, 2004

12）Prandoni P, Lensing AW, Prins MH, et al：Below-knee elastic compression stockings to prevent the post-thrombotic syndrome：a randomized, controlled trial. Ann Intern Med 141：249-256, 2004

13）Killewich LA, Macko RF, Cox K, et al：Regression of proximal deep venous thrombosis is associated with fibrinolytic enhancement. J Vasc Surg 26：861-868, 1997

14）Killewich LA, Bedford GR, Beach KW, et al：Spontaneous lysis of deep venous thrombi：rate and outcome. Vasc Surg 9：89-97, 1989

15）Girard P, Tardy B, Decousus H：Inferior vena cava interruption：how and when. Annu Rev 51：1-15, 2000

16）Kaufman JA, Kinney TB, Streiff MB, et al：Guidelines for the use of retrievable and convertible vena cava filters：report from the Society of Interventional Radiology Multidisciplinary Consensus Conference. J Vasc Interv Radiol 17：449-459, 2006

17）Gras s i CJ, Swan TL, Cardel la JF, et al：Quality improvement guidelines for percutaneous permanent inferior vena cava filter placement for the prevention of pulmonary embolism. J Vasc Interv Radiol 14：S271-S275, 2003