下肢不同部位深静脉血栓抗凝疗程的研究新进展

doi:10.12114/j.issn.1007-9572.2024.0472

中国全科医学 ›› 2025, Vol. 28 ›› Issue (29): 3721-3728.DOI: 10.12114/j.issn.1007-9572.2024.0472

• 综述与专论 • 上一篇

下肢不同部位深静脉血栓抗凝疗程的研究新进展

马景滔¹, 黄劼²^,^*(), 张烨², 陈萌¹, 张智颖¹

1．314001　浙江省嘉兴市，浙江中医药大学
2．314001　浙江省嘉兴市，嘉兴大学附属医院　嘉兴市第一医院全科医学科

收稿日期:2024-08-10 修回日期:2024-11-15 出版日期:2025-10-15 发布日期:2025-08-26
通讯作者: 黄劼
作者贡献：
马景滔进行文章的构思与设计，撰写论文；黄劼、张烨、陈萌进行文章的可行性分析；马景滔、陈萌、张智颖进行文献/资料收集；马景滔、张智颖进行文献/资料整理；马景滔、张烨进行论文的修订；黄劼、张烨负责文章的质量控制及审校；黄劼对文章整体负责，监督管理。
基金资助:
浙江省嘉兴市医学重点学科建设项目(2023-FC-002); 嘉兴市科技计划项目(2022AD30071); 嘉兴市第一医院科技计划项目(2023-YB-086)

Research Progress on Anticoagulant Therapy for Deep Vein Thrombosis in Different Parts of the Lower Extremity

MA Jingtao¹, HUANG Jie²^,^*(), ZHANG Ye², CHEN Meng¹, ZHANG Zhiying¹

1. Zhejiang Chinese Medical University, Jiaxing 314001, China
2. Department of General Practice, Affiliated Hospital of Jiaxing University/The First Hospital of Jiaxing, Jiaxing 314001, China

Received:2024-08-10 Revised:2024-11-15 Published:2025-10-15 Online:2025-08-26
Contact: HUANG Jie

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摘要/Abstract

摘要： 下肢深静脉血栓形成（LEDVT）是常见的血管疾病之一，发病率逐年上升，目前对该疾病的治疗已有广泛研究，但疾病的个性化最优管理甚少。本文从下肢不同部位系统探讨了该疾病的血栓抗凝时间，并通过梳理相关文献，总结了目前小腿肌间静脉、小腿轴静脉、股腘静脉以及髂股静脉等不同部位抗凝疗程的循证建议。本文认为在下肢不同部位的深静脉血管中，远端深静脉血栓形成（DDVT）发生率高，而近端深静脉血栓形成（PDVT）并发肺栓塞（PE）和血栓形成后综合征（PTS）的概率更大。DDVT抗凝推荐采用短期抗凝（2~6周），延长抗凝疗程并不会带来更多的好处，相反还会增加出血风险；PDVT及混合型LEDVT应采用中长期抗凝（≥3个月），特别是未达到介入治疗指征的股腘深静脉血栓形成（FDVT）。无限期的抗凝治疗仅是延迟血栓栓塞的复发，并没有真正降低血栓复发风险。本文可为深入了解LEDVT和优化其抗凝疗程，以及为LEDVT的个性化抗凝治疗提供参考。

关键词: 下肢深静脉血栓形成, 抗凝疗程, 肺栓塞, 远端深静脉血栓形成, 近端深静脉血栓形成

Abstract:

Lower extremity deep vein thrombosis (LEDVT) is one of the common vascular diseases with its incidence increasing annually. Although extensive research has focused on treating LEDVT, personalized management strategies remain limited. This review systematically discussed the recommended duration of anticoagulant therapy for LEDVT in various locations of the lower extremities and summarized the evidence-based recommendations for the anticoagulation treatment of different parts of the calf intermuscular vein, calf axial vein, femoropopliteal vein, and iliofemoral vein. This review further emphasized that in different parts of the lower extremities, the incidence of distal deep vein thrombosis (DDVT) was high, while the probability of proximal deep vein thrombosis (PDVT) complicated with pulmonary embolism (PE) and post-thrombosis syndrome (PTS) was greater. Short-term anticoagulation (2-6 weeks) was recommended for DDVT. A prolonged anticoagulation course could not bring more benefits, whereas increased the risk of bleeding. PDVT and mixed LEDVT of lower extremities should be treated with medium and long-term anticoagulation (≥ 3 months), especially for femoropopliteal deep vein thrombosis (FDVT) that did not meet the indications of interventional treatment. Indefinite anticoagulation treatment only delayed the recurrence of thromboembolism, but did not really reduce the risk of thrombosis recurrence. The results of this review could provide reference for further understanding of LEDVT and optimization of anticoagulation course, as well as for personalized anticoagulation treatment of LEDVT.

Key words: Lower extremity deep vein thrombosis, Anticoagulation therapy, Pulmonary embolism, Distal deep vein thrombosis, Proximal deep vein thrombosis

中图分类号:

R 543

马景滔,黄劼,张烨,等. 下肢不同部位深静脉血栓抗凝疗程的研究新进展[J]. 中国全科医学, 2025, 28(29): 3721-3728. DOI: 10.12114/j.issn.1007-9572.2024.0472.
MA Jingtao,HUANG Jie,ZHANG Ye, et al. Research Progress on Anticoagulant Therapy for Deep Vein Thrombosis in Different Parts of the Lower Extremity[J]. Chinese General Practice, 2025, 28(29): 3721-3728. DOI: 10.12114/j.issn.1007-9572.2024.0472.

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下肢不同部位深静脉血栓抗凝疗程的研究新进展

Research Progress on Anticoagulant Therapy for Deep Vein Thrombosis in Different Parts of the Lower Extremity

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