282.2 🩺 國考版

282.2.1 高頻考點

282.2.1.1 Virchow’s Triad

  • Stasis + hypercoagulability + endothelial injury

282.2.1.2 Inherited Thrombophilias

  • Factor V Leiden (most common in Caucasians, APC resistance)
  • Prothrombin G20210A
  • Protein C, S, antithrombin deficiency
  • Hyperhomocysteinemia

282.2.1.3 Acquired Thrombophilias

  • APS (lupus anticoagulant, anticardiolipin, anti-β2-GPI)
  • Cancer (paraneoplastic, TF)
  • HIT
  • Pregnancy, OCP, HRT
  • Nephrotic syndrome, PNH

282.2.1.4 DOAC Doses

  • Apixaban: 10 mg BID × 7d → 5 mg BID; reduce 2.5 BID for extended
  • Rivaroxaban: 15 mg BID × 21d → 20 mg daily; reduce 10 mg for extended
  • Edoxaban: 60 mg daily (after 5-10d parenteral)
  • Dabigatran: 150 mg BID (after 5-10d parenteral)

282.2.1.5 Key Trials

  • EINSTEIN-PE/DVT: rivaroxaban
  • AMPLIFY: apixaban
  • Hokusai-VTE: edoxaban
  • RE-COVER: dabigatran
  • Caravaggio: apixaban in cancer-VTE
  • TRAPS: DOAC inferior in triple-positive APS
  • PEITHO: full-dose tPA in submassive PE — ↓ death/hemodynamic deterioration but ↑ major bleeding (esp ICH)

282.2.1.6 When to Use What

  • DOAC: most patients (cancer, non-cancer)
  • Warfarin: mechanical valve, APS triple positive
  • LMWH: pregnancy, GI/GU cancer
  • Catheter therapy: massive PE, contraindication to lysis, with PERT

282.2.2 易混淆比范

Feature DVT PE
Symptoms Leg pain, swelling Dyspnea, chest pain, syncope
Imaging Compression US CTPA
Wells Yes Yes
D-dimer Yes Yes
Risk strat N/A Mass/submassive/low
Lysis Massive iliofemoral phlegmasia Massive PE

282.2.2.1 PE Risk Categories

Category Hemodynamic RV Dysfunction Biomarker Treatment
High (massive) Yes Yes Yes Thrombolysis / CDT
Intermediate-high No Yes Yes AC + monitor; consider CDT
Intermediate-low No One of (RV or bio) One of AC
Low No No No AC, consider outpatient