急性中風病人的靜脈血栓栓塞預防

Prophylaxis of Venous Thromboembolism in Acute Stroke Patients

靜脈血栓栓塞（venous thromboembolism，VTE）包括深層靜脈血栓形成（deep vein thrombosis，DVT）和肺栓塞（pulmonary embolism），是住院中會發生、但可以事先預防的重要併發症。VTE會增加不必要的醫療支出，也會造成突發的死亡，產生潛在的醫療爭議。美、英兩國已經將VTE預防，訂為所有住院病人照護的品質指標，成為國家政策，並且反映在醫療給付上。亞洲國家的VTE有增加的趨勢，日本國民健康保險已經給付VTE的預防。中風病人是VTE的高危險群，各種治療指引也針對中風病人VTE的預防，提供一些建議。本文將回顧VTE預防的發展、探討亞洲急性中風病人DVT的發生率、並整理相關預防指引的建議，以提供醫療行政人員與臨床醫療人員，做為政策制定與病人照護的參考。

Venous thromboembolism (VTE) includes deep vein thrombosis (DVT) and pulmonary embolism. VTE is an important hospital-acquired, preventable condition. VTE increases medical cost and leads to unpredictable mortality and sometimes medico-legal problems. The United States of America and the United Kingdom have established national policies and performance measures on VTE prophylaxis for all hospitalized patients. The incidence of VTE in Asians increased in the past decades. In Japan, VTE prophylaxis is covered by the National Health Insurance. Stroke is an important risk factor for VTE. Several guidelines recommend VTE prophylaxis for stroke patients. This article will review the progress of VTE prophylaxis and DVT incidence in Asian patients with acute stroke. A summary of VTE prophylaxis for acute stroke patients will be provided based on review of guideline recommendations and additional clinical evidence. The aim of this article is to provide a comprehensive review for health policy makers and clinical staff.