美国卫生服务与质量研究所评估认为血栓的预防治疗是住院患者第一位的安全策略。[2]Shojania KG, Duncan BW, McDonald KM, et al. Making health care safer: a critical analysis of patient safety practices. Evid Rep Technol Assess (Summ). 2001;(43):i-x;1-668.https://www.ncbi.nlm.nih.gov/books/NBK26966/http://www.ncbi.nlm.nih.gov/pubmed/11510252?tool=bestpractice.com 收治入院患者的疾病负担日益加重,且制动让这些患者成为患静脉血栓栓塞的最好发人群。若不进行预防,则住院期间深静脉血栓形成 (DVT) 的发病率在内科患者中约为 10%-20%,在普通外科患者中为 15-40%,骨科患者为 40%-60%。[3]Gould MK, Garcia DA, Wren SM, et al. Prevention of VTE in nonorthopedic surgical patients: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012 Feb;141(2 Suppl):e227S-77S.https://journal.chestnet.org/article/S0012-3692(12)60125-1/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/22315263?tool=bestpractice.com[4]National Institute for Health and Care Excellence. Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism. Mar 2018 [internet publication].https://www.nice.org.uk/guidance/ng89 根据美国卫生服务与质量研究所的报告,肺栓塞仍旧是住院期间最为多见但可预防的死亡原因。[2]Shojania KG, Duncan BW, McDonald KM, et al. Making health care safer: a critical analysis of patient safety practices. Evid Rep Technol Assess (Summ). 2001;(43):i-x;1-668.https://www.ncbi.nlm.nih.gov/books/NBK26966/http://www.ncbi.nlm.nih.gov/pubmed/11510252?tool=bestpractice.com 一项美国的大型研究表明,术后发生静脉血栓在导致住院时间延长的各种常见原因中排第二位。[5]Zhan C, Miller MR. Excess length of stay, charges, and mortality attributable to medical injuries during hospitalization. JAMA. 2003 Oct 8;290(14):1868-74.https://jamanetwork.com/journals/jama/fullarticle/197442http://www.ncbi.nlm.nih.gov/pubmed/14532315?tool=bestpractice.com 并且对肺栓塞及深静脉血栓为期3个月的抗凝治疗中存在显著的出血风险。[3]Gould MK, Garcia DA, Wren SM, et al. Prevention of VTE in nonorthopedic surgical patients: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012 Feb;141(2 Suppl):e227S-77S.https://journal.chestnet.org/article/S0012-3692(12)60125-1/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/22315263?tool=bestpractice.com 尽管给予了足够的抗凝治疗,仍有相当一部分患者产生了长期的并发症。大约 3% 的肺栓塞患者出现慢性肺动脉高压,20%~50% 有深静脉血栓形成的患者出现血栓后综合征(也称为静脉炎后综合征)。[6]Becattini C, Agnelli G, Pesavento R, et al. Incidence of chronic thromboembolic pulmonary hypertension after a first episode of pulmonary embolism. Chest. 2006 Jul;130(1):172-5.http://www.ncbi.nlm.nih.gov/pubmed/16840398?tool=bestpractice.com[7]Pengo V, Lensing AW, Prins MH, et al; Thromboembolic Pulmonary Hypertension Study Group. Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med. 2004 May 27;350(22):2257-64.https://www.nejm.org/doi/10.1056/NEJMoa032274http://www.ncbi.nlm.nih.gov/pubmed/15163775?tool=bestpractice.com[8]Kahn SR, Ginsberg JS. The post-thrombotic syndrome: current knowledge, controversies, and directions for future research. Blood Rev. 2002 Sep;16(3):155-65.http://www.ncbi.nlm.nih.gov/pubmed/12163001?tool=bestpractice.com