Yoğun Bakım Hastalarında Venöz Tromboembolizm
Özet
Bu çalışma, yoğun bakım hastalarında venöz tromboembolizm (VTE) riskini, patofizyolojisini, klinik belirtilerini, tanı yöntemlerini, profilaksi ve tedavi yaklaşımlarını ele almaktadır. VTE, derin ven trombozu (DVT) ve pulmoner emboliyi (PE) kapsayan ciddi bir durum olup, yoğun bakım hastaları immobilizasyon, sepsis ve invaziv işlemler nedeniyle yüksek risk altındadır. Patofizyoloji, virchow üçlüsüne (venöz staz, endotelyal hasar, hiperkoagülabilite) dayanmakta ve sepsis, travma, cerrahi ve sedasyon gibi faktörlerle tromboz riski artmaktadır. Klinik olarak DVT ekstremitede şişlik, ağrı, kızarıklık ile kendini gösterirken, PE nefes darlığı, taşikardi, göğüs ağrısı ve senkop gibi belirtilerle ortaya çıkabilir; tanıda D-dimer, Doppler USG, BT anjiyografi ve ekokardiyografi kullanılmaktadır. Profilaksi kapsamında farmakolojik yöntemler (DMAH, UFH, DOAK’lar) ve mekanik yöntemler (kompresyon çorapları, aralıklı pnömatik kompresyon) uygulanmaktadır. Stabil hastalarda antikoagülan tedavi (DMAH, DOAK) tercih edilirken, instabil (masif PE) hastalarda trombolitik tedavi (Alteplaz) ve girişimsel yöntemler (kateter trombektomi, embolektomi) kullanılmaktadır. Sepsis, nörolojik yoğun bakım hastaları, travma ve yanık hastaları gibi özel gruplarda bireyselleştirilmiş profilaksi ve tedavi stratejileri önerilmektedir. Gelecekte, biyobelirteçler, yapay zeka destekli risk değerlendirme sistemleri ve yeni nesil antikoagülanlarla VTE yönetiminin daha da iyileştirilmesi hedeflenmektedir.
This study examines the risk, pathophysiology, clinical manifestations, diagnostic methods, prophylaxis, and treatment approaches of venous thromboembolism (VTE) in intensive care unit (ICU) patients. VTE, which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a serious condition, and ICU patients are at high risk due to immobilization, sepsis, and invasive procedures. The pathophysiology is based on virchow’s triad (venous stasis, endothelial injury, and hypercoagulability), with factors such as sepsis, trauma, surgery, and sedation further increasing the risk of thrombosis. Clinically, DVT presents with limb swelling, pain, and erythema, while PE manifests as dyspnea, tachycardia, chest pain, and syncope; diagnostic methods include D-dimer, Doppler ultrasound, CT angiography, and echocardiography. Prophylaxis consists of pharmacological methods (low-molecular-weight heparin [LMWH], unfractionated heparin [UFH], and direct oral anticoagulants [DOACs]) and mechanical methods (compression stockings and intermittent pneumatic compression). In stable patients, anticoagulant therapy (LMWH, DOACs) is preferred, whereas in unstable (massive PE) patients, thrombolytic therapy (alteplase) and interventional procedures (catheter-directed thrombectomy, embolectomy) are utilized. Individualized prophylaxis and treatment strategies are recommended for special populations, including patients with sepsis, neurological conditions, trauma, and burns. In the future, biomarkers, artificial intelligence-based risk assessment systems, and novel anticoagulants are expected to enhance VTE management.
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