{"id":32229,"date":"2023-05-07T13:31:36","date_gmt":"2023-05-07T06:31:36","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=32229"},"modified":"2023-05-18T10:10:21","modified_gmt":"2023-05-18T03:10:21","slug":"dieu-tri-man-tinh-o-benh-nhan-thuyen-tac-phoi-esc-2019","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/07\/dieu-tri-man-tinh-o-benh-nhan-thuyen-tac-phoi-esc-2019\/","title":{"rendered":"\u0110i\u1ec1u tr\u1ecb m\u1ea1n t\u00ednh \u1edf b\u1ec7nh nh\u00e2n thuy\u00ean t\u1eafc ph\u1ed5i &#8211; ESC 2019"},"content":{"rendered":"<p><strong>Thuy\u00ean t\u1eafc ph\u1ed5i (PE)\u00a0 l\u00e0 t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00fd g\u00e2y ra do \u0111\u1ed9ng m\u1ea1ch trong ph\u1ed5i b\u1ecb t\u1eafc ngh\u1ebdn. B\u00ean c\u1ea1nh vi\u1ec7c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh l\u00fd c\u1ea5p t\u00ednh n\u00e0y ch\u00fang ta c\u1ea7n ph\u1ea3i t\u1ed1i \u01b0u vi\u1ec7c \u0111i\u1ec1u tr\u1ecb m\u1ea1n t\u00ednh v\u00e0 ph\u00f2ng ng\u1eeba t\u00e1i ph\u00e1t \u0111\u1ec3 ng\u0103n ch\u1eb7n t\u00ecnh tr\u1ea1ng b\u1ec7nh tr\u1edf n\u00ean t\u1ed3i t\u1ec7 h\u01a1n.<\/strong><\/p>\n<figure id=\"attachment_32237\" aria-describedby=\"caption-attachment-32237\" style=\"width: 496px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\" wp-image-32237\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/aa.jpg\" alt=\"thuyen-tac-phoi\" width=\"496\" height=\"372\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/aa.jpg 800w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/aa-300x225.jpg 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/aa-768x576.jpg 768w\" sizes=\"(max-width: 496px) 100vw, 496px\" \/><figcaption id=\"caption-attachment-32237\" class=\"wp-caption-text\">\u1ea2nh m\u00f4 t\u1ea3 thuy\u00ean t\u1eafc ph\u1ed5i do huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch s\u00e2u ( DVT) t\u1eeb t\u0129nh m\u1ea1ch \u0111\u00f9i<\/figcaption><\/figure>\n<h2>1. T\u1ed5ng quan<\/h2>\n<p><span style=\"font-weight: 400;\">M\u1ee5c \u0111\u00edch c\u1ee7a kh\u00e1ng \u0111\u00f4ng sau thuy\u00ean t\u1eafc ph\u1ed5i c\u1ea5p l\u00e0 ho\u00e0n th\u00e0nh <strong>th\u1eddi gian \u0111i\u1ec1u tr\u1ecb giai \u0111o\u1ea1n c\u1ea5p v\u00e0 ng\u0103n ng\u1eeba t\u00e1i ph\u00e1t VTE<\/strong> h\u01a1n l\u00e0 s\u1eed d\u1ee5ng l\u00e2u d\u00e0i. C\u00e1c lo\u1ea1i thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng m\u00e1u v\u00e0 l\u1ed9 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb kh\u1edfi \u0111\u1ea7u c\u0169ng nh\u01b0 nh\u1eefng th\u00e1ng \u0111\u1ea7u ti\u00ean.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0H\u1ea7u h\u1ebft c\u00e1c nghi\u00ean c\u1ee9u ng\u1eabu nhi\u00ean t\u1eadp trung v\u00e0o ch\u1ed1ng \u0111\u00f4ng m\u00e1u l\u00e2u d\u00e0i cho thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch (VTE) \u0111\u1ec1u g\u1ed3m nh\u1eefng b\u1ec7nh nh\u00e2n DVT, c\u00f3 ho\u1eb7c kh\u00f4ng c\u00f3 PE; ch\u1ec9 c\u00f3 hai nghi\u00ean c\u1ee9u ng\u1eabu nhi\u00ean t\u1eadp trung v\u00e0o b\u1ec7nh nh\u00e2n PE. T\u1ef7 su\u1ea5t m\u1eafc VTE t\u00e1i ph\u00e1t kh\u00f4ng ph\u1ee5 thu\u1ed9c v\u00e0o bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u1ee7a l\u1ea7n m\u1eafc \u0111\u1ea7u ti\u00ean (ngh\u0129a l\u00e0 t\u1ef7 su\u1ea5t t\u00e1i ph\u00e1t gi\u1ed1ng nhau sau PE hay sau DVT \u0111o\u1ea1n g\u1ea7n). Tuy nhi\u00ean, \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n t\u1eebng m\u1eafc PE th\u00ec VTE th\u01b0\u1eddng t\u00e1i ph\u00e1t \u1edf d\u1ea1ng PE h\u01a1n, trong khi \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u00e3 b\u1ecb DVT, VTE l\u1ea1i c\u00f3 xu h\u01b0\u1edbng t\u00e1i ph\u00e1t \u1edf d\u1ea1ng DVT. Th\u00e0nh ra, t\u1ef7 l\u1ec7 t\u1eed vong c\u1ee7a VTE t\u00e1i ph\u00e1t \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n tr\u01b0\u1edbc \u0111\u00e2y c\u00f3 PE cao g\u1ea5p \u0111\u00f4i so v\u1edbi VTE t\u00e1i ph\u00e1t sau DVT.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0C\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng \u0111\u00e3 \u0111\u00e1nh gi\u00e1 c\u00e1c kho\u1ea3ng th\u1eddi gian kh\u00e1c nhau \u0111i\u1ec1u tr\u1ecb ch\u1ed1ng \u0111\u00f4ng m\u00e1u b\u1eb1ng VKA cho VTE. K\u1ebft qu\u1ea3 c\u1ee7a nh\u1eefng nghi\u00ean c\u1ee9u n\u00e0y \u0111\u01b0a ra nh\u1eefng k\u1ebft lu\u1eadn sau \u0111\u00e2y. \u0110\u1ea7u ti\u00ean, t\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n thuy\u00ean t\u1eafc ph\u1ed5i n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb ch\u1ed1ng \u0111\u00f4ng m\u00e1u <strong>\u22653 th\u00e1ng<\/strong>. Th\u1ee9 hai, sau khi ng\u1eebng \u0111i\u1ec1u tr\u1ecb ch\u1ed1ng \u0111\u00f4ng, nguy c\u01a1 t\u00e1i ph\u00e1t d\u1ef1 ki\u1ebfn s\u1ebd t\u01b0\u01a1ng t\u1ef1 n\u1ebfu ng\u1eebng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng sau 3-6 th\u00e1ng so v\u1edbi th\u1eddi gian \u0111i\u1ec1u tr\u1ecb d\u00e0i h\u01a1n (v\u00ed d\u1ee5: 12-24 th\u00e1ng). Th\u1ee9 ba, \u0111i\u1ec1u tr\u1ecb ch\u1ed1ng \u0111\u00f4ng b\u1eb1ng \u0111\u01b0\u1eddng u\u1ed1ng k\u00e9o d\u00e0i l\u00e0m <strong>gi\u1ea3m nguy c\u01a1 VTE t\u00e1i ph\u00e1t c\u00f2n \u226490%<\/strong>, nh\u01b0ng l\u1ee3i \u00edch n\u00e0y \u0111i k\u00e8m v\u1edbi nguy c\u01a1 ch\u1ea3y m\u00e1u.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng c\u00f3 hi\u1ec7u qu\u1ea3 cao trong vi\u1ec7c ng\u0103n ng\u1eeba t\u00e1i ph\u00e1t VTE trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb, nh\u01b0ng n\u00f3 kh\u00f4ng lo\u1ea1i tr\u1eeb nguy c\u01a1 t\u00e1i ph\u00e1t sau khi ng\u1eebng \u0111i\u1ec1u tr\u1ecb. M\u1ed9t m\u1eb7t d\u1ef1a tr\u00ean th\u1ef1c t\u1ebf n\u00e0y v\u00e0 m\u1eb7c kh\u00e1c xem x\u00e9t nguy c\u01a1 ch\u1ea3y m\u00e1u c\u1ee7a \u0111i\u1ec1u tr\u1ecb ch\u1ed1ng \u0111\u00f4ng m\u00e1u, c\u00e2u h\u1ecfi l\u00e2m s\u00e0ng quan tr\u1ecdng l\u00e0 l\u00e0m th\u1ebf n\u00e0o \u0111\u1ec3 ch\u1ecdn \u1ee9ng vi\u00ean t\u1ed1t nh\u1ea5t cho vi\u1ec7c k\u00e9o d\u00e0i c\u00f3 th\u1eddi h\u1ea1n ho\u1eb7c kh\u00f4ng th\u1eddi h\u1ea1n \u0111i\u1ec1u tr\u1ecb kh\u00e1ng \u0111\u00f4ng. S\u1ef1 tham gia c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0o qu\u00e1 tr\u00ecnh ra quy\u1ebft \u0111\u1ecbnh l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 t\u1ed1i \u01b0u h\u00f3a v\u00e0 duy tr\u00ec tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb.<\/span><\/p>\n<h2>2. \u0110i\u1ec1u tr\u1ecb m\u1ea1n t\u00ednh v\u00e0 ph\u00f2ng ng\u1eeba t\u00e1i ph\u00e1t thuy\u00ean t\u1eafc ph\u1ed5i<\/h2>\n<h3><strong>\u00a02.1 <a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/benh-ly-thuyen-tac-huyet-khoi-tinh-mach\/\">\u0110\u00e1nh gi\u00e1 nguy c\u01a1 t\u00e1i ph\u00e1t thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch<\/a> (VTE)\u00a0<\/strong><\/h3>\n<p><span style=\"font-weight: 400;\">Nguy c\u01a1 t\u00e1i ph\u00e1t VTE sau khi ng\u1eebng \u0111i\u1ec1u tr\u1ecb c\u00f3 li\u00ean quan \u0111\u1ebfn c\u00e1c t\u00ednh ch\u1ea5t c\u1ee7a \u0111\u1ee3t c\u1ea5p thuy\u00ean t\u1eafc ph\u1ed5i (ho\u1eb7c, theo ngh\u0129a r\u1ed9ng h\u01a1n, VTE). M\u1ed9t nghi\u00ean c\u1ee9u theo d\u00f5i b\u1ec7nh nh\u00e2n sau l\u1ea7n PE c\u1ea5p t\u00ednh \u0111\u1ea7u ti\u00ean, th\u1ea5y r\u1eb1ng t\u1ef7 l\u1ec7 t\u00e1i ph\u00e1t sau khi ng\u1eebng \u0111i\u1ec1u tr\u1ecb l\u00e0 2.5% m\u1ed7i n\u0103m sau m\u1eafc thuy\u00ean t\u1eafc ph\u1ed5i, c\u00f3 li\u00ean quan \u0111\u1ebfn c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 tho\u00e1ng qua, so v\u1edbi 4.5% m\u1ed7i n\u0103m sau m\u1eafc thuy\u00ean t\u1eafc ph\u1ed5i m\u00e0 kh\u00f4ng c\u00f3 ung th\u01b0 tr\u01b0\u1edbc \u0111\u00f3, b\u1ec7nh l\u00fd t\u0103ng \u0111\u00f4ng m\u00e1u \u0111\u00e3 bi\u1ebft ho\u1eb7c b\u1ea5t k\u1ef3 y\u1ebfu t\u1ed1 nguy c\u01a1 tho\u00e1ng qua n\u00e0o. Nh\u1eefng quan s\u00e1t t\u01b0\u01a1ng t\u1ef1 \u0111\u00e3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n trong c\u00e1c nghi\u00ean c\u1ee9u ti\u1ebfn c\u1ee9u kh\u00e1c \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n m\u1eafc DVT. N\u00f3i s\u00e2u h\u01a1n v\u1ec1 c\u00e1c kh\u00e1i ni\u1ec7m, c\u00e1c th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean v\u1ec1 ch\u1ed1ng \u0111\u00f4ng trong 15 n\u0103m qua t\u1eadp trung v\u00e0o ph\u00f2ng ng\u1eeba VTE th\u1ee9 ph\u00e1t, \u0111\u00e3 ph\u00e2n lo\u1ea1i b\u1ec7nh nh\u00e2n th\u00e0nh c\u00e1c nh\u00f3m ri\u00eang bi\u1ec7t d\u1ef1a tr\u00ean nguy c\u01a1 t\u00e1i ph\u00e1t VTE sau khi ng\u01b0ng \u0111i\u1ec1u tr\u1ecb kh\u00e1ng \u0111\u00f4ng. T\u1ed5ng quan c\u00e1c nh\u00f3m n\u00e0y l\u00e0:<\/span><\/p>\n<p><span style=\"font-weight: 400;\"><strong> (i)<\/strong> B\u1ec7nh nh\u00e2n c\u00f3 m\u1ed9t y\u1ebfu t\u1ed1 nguy c\u01a1 (ch\u00ednh) m\u1ea1nh nh\u1ea5t th\u1eddi ho\u1eb7c c\u00f3 th\u1ec3 h\u1ed3i ph\u1ee5c, ph\u1ed5 bi\u1ebfn nh\u1ea5t l\u00e0 ph\u1eabu thu\u1eadt l\u1edbn ho\u1eb7c ch\u1ea5n th\u01b0\u01a1ng, c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh l\u00e0 nguy\u00ean nh\u00e2n c\u1ee7a l\u1ea7n c\u1ea5p t\u00ednh n\u00e0y;<\/span><\/p>\n<p><span style=\"font-weight: 400;\"><strong>(ii)<\/strong> B\u1ec7nh nh\u00e2n c\u00f3 PE c\u1ea5p c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c gi\u1ea3i th\u00edch m\u1ed9t ph\u1ea7n b\u1edfi s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a m\u1ed9t y\u1ebfu t\u1ed1 nguy c\u01a1 y\u1ebfu (ph\u1ee5) t\u1ea1m th\u1eddi hay c\u00f3 th\u1ec3 h\u1ed3i ph\u1ee5c, hay c\u00f3 m\u1ed9t y\u1ebfu t\u1ed1 nguy c\u01a1 g\u00e2y t\u0103ng huy\u1ebft kh\u1ed1i kh\u00f4ng \u00e1c t\u00ednh;<\/span><\/p>\n<p><span style=\"font-weight: 400;\"><strong>(iii)<\/strong> B\u1ec7nh nh\u00e2n c\u00f3 thuy\u00ean t\u1eafc ph\u1ed5i c\u1ea5p m\u00e0 kh\u00f4ng c\u00f3 b\u1ea5t k\u1ef3 y\u1ebfu t\u1ed1 nguy c\u01a1 n\u00e0o c\u00f3 th\u1ec3 x\u00e1c \u0111\u1ecbnh (H\u01b0\u1edbng d\u1eabn hi\u1ec7n t\u1ea1i tr\u00e1nh c\u00e1c thu\u1eadt ng\u1eef nh\u01b0 VTE \u2018kh\u00f4ng c\u00f3 y\u1ebfu t\u1ed1 k\u00edch g\u1ee3i\u2019 ho\u1eb7c \u2018v\u00f4 c\u0103n\u2019);<\/span><\/p>\n<p><span style=\"font-weight: 400;\"><strong>\u00a0(iv)<\/strong> B\u1ec7nh nh\u00e2n c\u00f3 m\u1ed9t ho\u1eb7c nhi\u1ec1u l\u1ea7n VTE tr\u01b0\u1edbc \u0111\u00e2y v\u00e0 b\u1ec7nh nh\u00e2n c\u00f3 t\u00ecnh tr\u1ea1ng d\u1ec5 t\u1ea1o huy\u1ebft kh\u1ed1i dai d\u1eb3ng nh\u01b0 <a href=\"https:\/\/www.vinmec.com\/vi\/benh\/hoi-chung-khang-the-khang-phospholipid-3732\/\">h\u1ed9i ch\u1ee9ng kh\u00e1ng th\u1ec3 kh\u00e1ng phospholipid<\/a>;\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\"><strong>(v)<\/strong> <a href=\"https:\/\/www.vietnamplus.vn\/vinmec-trien-khai-dieu-tri-ung-thu-bang-lieu-phap-mien-dich-tu-than\/557685.vnp\">B\u1ec7nh nh\u00e2n ung th\u01b0 ti\u1ebfn tri\u1ec3n.<\/a><\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0B\u1ea3ng 11 cho th\u1ea5y c\u00e1c v\u00ed d\u1ee5 v\u1ec1 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 tho\u00e1ng qua\/c\u00f3 th\u1ec3 h\u1ed3i ph\u1ee5c v\u00e0 dai d\u1eb3ng \u0111\u1ed1i v\u1edbi VTE, \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i theo nguy c\u01a1 t\u00e1i ph\u00e1t l\u00e2u d\u00e0i. V\u00ec ung th\u01b0 ti\u1ebfn tri\u1ec3n l\u00e0 <strong>y\u1ebfu t\u1ed1 nguy c\u01a1 ch\u00ednh g\u00e2y t\u00e1i ph\u00e1t VTE,<\/strong> nh\u01b0ng c\u0169ng g\u00e2y ch\u1ea3y m\u00e1u khi \u0111i\u1ec1u tr\u1ecb kh\u00e1ng \u0111\u00f4ng, ph\u1ea7n 2.5 l\u00e0 \u0111\u1eb7c bi\u1ec7t d\u00e0nh ri\u00eang cho vi\u1ec7c qu\u1ea3n l\u00fd thuy\u00ean t\u1eafc ph\u1ed5i \u1edf b\u1ec7nh nh\u00e2n ung th\u01b0.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Nh\u00ecn chung, \u0111\u00e1nh gi\u00e1 nguy c\u01a1 t\u00e1i ph\u00e1t VTE sau PE c\u1ea5p t\u00ednh, m\u00e0 kh\u00f4ng c\u00f3 y\u1ebfu t\u1ed1 nguy c\u01a1 tho\u00e1ng qua ho\u1eb7c c\u00f3 th\u1ec3 h\u1ed3i ph\u1ee5c, l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 ph\u1ee9c t\u1ea1p. Ngo\u00e0i c\u00e1c v\u00ed d\u1ee5 \u0111\u01b0\u1ee3c li\u1ec7t k\u00ea trong B\u1ea3ng 11, nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh l\u00fd t\u0103ng \u0111\u00f4ng di truy\u1ec1n, \u0111\u1eb7c bi\u1ec7t l\u00e0 nh\u1eefng ng\u01b0\u1eddi thi\u1ebfu h\u1ee5t antithrombin, protein C ho\u1eb7c protein S v\u00e0 b\u1ec7nh nh\u00e2n c\u00f3 y\u1ebfu t\u1ed1 \u0111\u1ed3ng h\u1ee3p t\u1eed V Leiden ho\u1eb7c \u0111\u1ed9t bi\u1ebfn gen prothrombin G20210A \u0111\u1ed3ng h\u1ee3p t\u1eed, th\u01b0\u1eddng l\u00e0 \u1ee9ng c\u1eed vi\u00ean cho \u0111i\u1ec1u tr\u1ecb ch\u1ed1ng \u0111\u00f4ng m\u00e1u v\u00f4 h\u1ea1n \u0111\u1ecbnh sau khi xu\u1ea5t hi\u1ec7n PE \u0111\u1ea7u ti\u00ean n\u1ebfu kh\u00f4ng c\u00f3 y\u1ebfu t\u1ed1 nguy c\u01a1 h\u1ed3i ph\u1ee5c \u0111\u01b0\u1ee3c. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">T\u1eeb \u0111\u00f3 c\u00f3 th\u1ec3 k\u1ebft lu\u1eadn, ki\u1ec3m tra b\u1ec7nh l\u00fd t\u0103ng \u0111\u00f4ng (bao g\u1ed3m h\u1ed9i ch\u1ee9ng kh\u00e1ng th\u1ec3 antiphospholipid v\u00e0 <a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/benh-lupus-ban-do-he-thong-la-gi\/\">\u0111\u00f4ng m\u00e1u do lupus<\/a>) c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc \u1edf b\u1ec7nh nh\u00e2n m\u1eafc VTE khi c\u00f2n tr\u1ebb (v\u00ed d\u1ee5: &lt;50 tu\u1ed5i) v\u00e0 khi kh\u00f4ng c\u00f3 y\u1ebfu t\u1ed1 nguy c\u01a1 n\u00e0o kh\u00e1c \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh, \u0111\u1eb7c bi\u1ec7t n\u00ean l\u00e0m x\u00e9t nghi\u1ec7m khi b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed gia \u0111\u00ecnh m\u1ea1nh m\u1eafc VTE. Trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p nh\u01b0 v\u1eady, x\u00e9t nghi\u1ec7m c\u00f3 th\u1ec3 gi\u00fap \u0111i\u1ec1u ch\u1ec9nh li\u1ec7u tr\u00ecnh v\u00e0 li\u1ec1u l\u01b0\u1ee3ng c\u1ee7a thu\u1ed1c kh\u00e1ng \u0111\u00f4ng khi d\u00f9ng th\u1eddi gian d\u00e0i. M\u1eb7t kh\u00e1c, hi\u1ec7n t\u1ea1i kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng v\u1ec1 l\u1ee3i \u00edch l\u00e2m s\u00e0ng c\u1ee7a \u0111i\u1ec1u tr\u1ecb ch\u1ed1ng \u0111\u00f4ng k\u00e9o d\u00e0i cho nh\u1eefng ng\u01b0\u1eddi mang y\u1ebfu t\u1ed1 d\u1ecb h\u1ee3p <a href=\"https:\/\/vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/chan-doan-roi-loan-tang-dong-mau\/\">V Leiden<\/a> ho\u1eb7c \u0111\u1ed9t bi\u1ebfn gen prothrombin 20210A.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">M\u1ed9t s\u1ed1 m\u00f4 h\u00ecnh d\u1ef1 \u0111o\u00e1n nguy c\u01a1 \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n cho \u0111\u00e1nh gi\u00e1 nguy c\u01a1 t\u00e1i ph\u00e1t \u1edf t\u1eebng b\u1ec7nh nh\u00e2n. Gi\u00e1 tr\u1ecb l\u00e2m s\u00e0ng v\u00e0 \u0111\u1eb7c bi\u1ec7t l\u00e0 \u00fd ngh\u0129a \u0111i\u1ec1u tr\u1ecb c\u00f3 th\u1ec3 c\u00f3 c\u1ee7a c\u00e1c m\u00f4 h\u00ecnh n\u00e0y trong th\u1eddi \u0111\u1ea1i <a href=\"https:\/\/vinmecdr.com\/noac-new-oral-anticoagulants-thuoc-khang-dong-duong-uong-the-he-moi-co-gi-dac-biet\/\">NOAC<\/a> l\u00e0 kh\u00f4ng r\u00f5 r\u00e0ng.\u00a0<\/span><\/p>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"aligncenter size-full wp-image-32232\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Screenshot-622.png\" alt=\"phan-loai-yeu-to-nguy-co-gay-thuyen-tac-phoi\" width=\"514\" height=\"719\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Screenshot-622.png 514w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Screenshot-622-214x300.png 214w\" sizes=\"(max-width: 514px) 100vw, 514px\" \/><\/p>\n<h3><strong>2.2. <a href=\"https:\/\/www.vinmec.com\/vi\/thong-tin-duoc\/su-dung-thuoc-toan\/luu-y-khi-dung-thuoc-chong-dong-mau\/\">Nguy c\u01a1 ch\u1ea3y m\u00e1u li\u00ean quan \u0111\u1ebfn thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng m\u00e1u<\/a><\/strong><\/h3>\n<p><span style=\"font-weight: 400;\">\u00a0\u01af\u1edbc t\u00ednh t\u1ef7 su\u1ea5t m\u1edbi m\u1eafc t\u1eeb c\u00e1c nghi\u00ean c\u1ee9u \u0111o\u00e0n h\u1ec7 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n h\u01a1n 15 n\u0103m tr\u01b0\u1edbc b\u00e1o c\u00e1o t\u1ef7 l\u1ec7 ch\u1ea3y m\u00e1u l\u1edbn h\u00e0ng n\u0103m l\u00e0 3% \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng VKA. Ph\u00e2n t\u00edch g\u1ed9p c\u00e1c nghi\u00ean c\u1ee9u pha III t\u1eadp trung v\u00e0o 3 &#8211; 12 th\u00e1ng \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb kh\u00e1ng \u0111\u00f4ng cho th\u1ea5y<strong> gi\u1ea3m ~40%<\/strong> nguy c\u01a1 ch\u1ea3y m\u00e1u l\u1edbn v\u1edbi NOAC so v\u1edbi VKA. Nguy c\u01a1 ch\u1ea3y m\u00e1u l\u1edbn cao h\u01a1n \u1edf th\u00e1ng \u0111i\u1ec1u tr\u1ecb kh\u00e1ng \u0111\u00f4ng \u0111\u1ea7u ti\u00ean, sau \u0111\u00f3 gi\u1ea3m d\u1ea7n v\u00e0 v\u1eabn \u1ed5n \u0111\u1ecbnh theo th\u1eddi gian. D\u1ef1a tr\u00ean b\u1eb1ng ch\u1ee9ng hi\u1ec7n c\u00f3, c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 bao g\u1ed3m:\u00a0<\/span><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">Tu\u1ed5i cao (\u0111\u1eb7c bi\u1ec7t &gt;75 tu\u1ed5i);<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Ch\u1ea3y m\u00e1u tr\u01b0\u1edbc \u0111\u00f3 (n\u1ebfu kh\u00f4ng li\u00ean quan \u0111\u1ebfn nguy\u00ean nh\u00e2n c\u00f3 th\u1ec3 h\u1ed3i ph\u1ee5c ho\u1eb7c \u0111i\u1ec1u\u00a0 \u00a0 \u00a0tr\u1ecb \u0111\u01b0\u1ee3c) ho\u1eb7c thi\u1ebfu m\u00e1u;\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Ung th\u01b0 ti\u1ebfn tri\u1ec3n;<\/span><\/li>\n<li><span style=\"font-weight: 400;\">\u0110\u1ed9t qu\u1ef5 tr\u01b0\u1edbc \u0111\u00f3, ho\u1eb7c xu\u1ea5t huy\u1ebft n\u00e3o ho\u1eb7c thi\u1ebfu m\u00e1u n\u00e3o;\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">B\u1ec7nh th\u1eadn ho\u1eb7c gan m\u1ea1n t\u00ednh;\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">\u0110i\u1ec1u tr\u1ecb \u0111\u1ed3ng th\u1eddi kh\u00e1ng ti\u1ec3u c\u1ea7u ho\u1eb7c thu\u1ed1c kh\u00e1ng vi\u00eam kh\u00f4ng steroid (tr\u00e1nh \u0111\u01b0\u1ee3c n\u1ebfu c\u00f3 th\u1ec3);\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">\u00a0B\u1ec7nh c\u1ea5p t\u00ednh ho\u1eb7c m\u1ea1n t\u00ednh nghi\u00eam tr\u1ecdng kh\u00e1c;\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400;\">\u00a0Ki\u1ec3m so\u00e1t ch\u1ed1ng \u0111\u00f4ng m\u00e1u k\u00e9m.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">\u00a0Nguy c\u01a1 ch\u1ea3y m\u00e1u c\u1ee7a b\u1ec7nh nh\u00e2n n\u00ean \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1, b\u1eb1ng c\u00e1ch \u0111\u00e1nh gi\u00e1 theo kinh nghi\u1ec7m d\u1ef1a v\u00e0o c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 t\u1eebng c\u00e1 nh\u00e2n ho\u1eb7c b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng thang \u0111i\u1ec3m nguy c\u01a1 ch\u1ea3y m\u00e1u, t\u1ea1i th\u1eddi \u0111i\u1ec3m b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb ch\u1ed1ng \u0111\u00f4ng m\u00e1u.\u00a0 N\u00ean \u0111\u00e1nh gi\u00e1 l\u1ea1i \u0111\u1ecbnh k\u1ef3 (v\u00ed d\u1ee5: m\u1ed7i n\u0103m m\u1ed9t l\u1ea7n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 th\u1ea5p v\u00e0 c\u1ee9 sau<strong> 3 ho\u1eb7c 6 th\u00e1ng<\/strong> \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 ch\u1ea3y m\u00e1u cao). S\u1ef1 \u0111\u00e1nh gi\u00e1 nguy c\u01a1 ch\u1ea3y m\u00e1u n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh v\u00e0 \u0111i\u1ec1u tr\u1ecb y\u1ebfu t\u1ed1 nguy c\u01a1 ch\u1ea3y m\u00e1u c\u00f3 th\u1ec3 thay \u0111\u1ed5i, v\u00e0 n\u00f3 c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn vi\u1ec7c ra quy\u1ebft \u0111\u1ecbnh th\u1eddi gian v\u00e0 ph\u00e1c \u0111\u1ed3\/li\u1ec1u thu\u1ed1c kh\u00e1ng \u0111\u00f4ng sau thuy\u00ean t\u1eafc ph\u1ed5i c\u1ea5p t\u00ednh<\/span><\/p>\n<h3><strong>2.3 Ph\u00e1c \u0111\u1ed3 v\u00e0 th\u1eddi gian \u0111i\u1ec1u tr\u1ecb v\u1edbi thu\u1ed1c kh\u00e1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng kh\u00f4ng kh\u00e1ng vitamin K, v\u00e0 c\u00e1c thu\u1ed1c ch\u1ed1ng huy\u1ebft kh\u1ed1i kh\u00f4ng kh\u00e1ng vitamin K kh\u00e1c.<\/strong><\/h3>\n<p><span style=\"font-weight: 400;\">\u00a0T\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n PE n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c kh\u00e1ng \u0111\u00f4ng \u22653 th\u00e1ng. Qua giai \u0111o\u1ea1n n\u00e0y, s\u1ef1 c\u00e2n b\u1eb1ng gi\u1eefa nguy c\u01a1 VTE t\u00e1i ph\u00e1t v\u00e0 nguy c\u01a1 ch\u1ea3y m\u00e1u, \u0111i\u1ec1u \u0111\u00e3 \u0111\u01b0\u1ee3c d\u00f9ng trong k\u1ef7 nguy\u00ean VKA \u0111\u1ec3 quy\u1ebft \u0111\u1ecbnh c\u00f3 ti\u1ebfp t\u1ee5c d\u00f9ng kh\u00e1ng \u0111\u00f4ng k\u00e9o d\u00e0i sau l\u1ea7n VTE \u0111\u1ea7u hay kh\u00f4ng, hi\u1ec7n \u0111ang \u0111\u01b0\u1ee3c xem x\u00e9t l\u1ea1i d\u1ef1a tr\u00ean t\u1ef7 l\u1ec7 ch\u1ea3y m\u00e1u th\u1ea5p h\u01a1n khi \u0111i\u1ec1u tr\u1ecb v\u1edbi NOAC. Tuy nhi\u00ean, m\u1eb7c d\u00f9 \u0111\u00e3 c\u1ea3i thi\u1ec7n \u0111\u1ed9 an to\u00e0n c\u1ee7a c\u00e1c thu\u1ed1c n\u00e0y so v\u1edbi VKA, \u0111i\u1ec1u tr\u1ecb v\u1edbi NOAC kh\u00f4ng ph\u1ea3i l\u00e0 kh\u00f4ng c\u00f3 r\u1ee7i ro. Th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng giai \u0111o\u1ea1n III tr\u00ean \u0111i\u1ec1u tr\u1ecb VTE k\u00e9o d\u00e0i \u0111\u00e3 ch\u1ec9 ra r\u1eb1ng t\u1ef7 l\u1ec7 ch\u1ea3y m\u00e1u l\u1edbn c\u00f3 th\u1ec3 l\u00e0 ~1% v\u00e0 t\u1ef7 l\u1ec7 ch\u1ea3y m\u00e1u kh\u00f4ng l\u1edbn c\u00f3 li\u00ean quan \u0111\u1ebfn l\u00e2m s\u00e0ng (CRNM) cao t\u1edbi 6%. T\u1ef7 l\u1ec7 ch\u1ea3y m\u00e1u c\u00f3 th\u1ec3 cao h\u01a1n trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng h\u00e0ng ng\u00e0y.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0Trong t\u1ea5t c\u1ea3 c\u00e1c nghi\u00ean c\u1ee9u, b\u1ec7nh nh\u00e2n thuy\u00ean t\u1eafc ph\u1ed5i chi\u1ebfm kho\u1ea3ng m\u1ed9t ph\u1ea7n ba c\u01a1 m\u1eabu nghi\u00ean c\u1ee9u, trong khi hai ph\u1ea7n ba c\u00f2n l\u1ea1i l\u00e0 nh\u1eefng b\u1ec7nh nh\u00e2n m\u1eafc DVT \u0111o\u1ea1n g\u1ea7n m\u00e0 kh\u00f4ng c\u00f3 bi\u1ec3u hi\u1ec7n PE. B\u1ec7nh nh\u00e2n c\u1ea7n ph\u1ea3i ho\u00e0n t\u1ea5t giai \u0111o\u1ea1n ch\u1ed1ng \u0111\u00f4ng ban \u0111\u1ea7u v\u00e0 d\u00e0i h\u1ea1n tr\u01b0\u1edbc khi \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o nghi\u00ean k\u00e9o d\u00e0i.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\"><a href=\"https:\/\/www.vinmec.com\/vi\/thong-tin-duoc\/su-dung-thuoc-toan\/thuoc-dabigatran-pradaxa-cong-dung-cach-dung-va-cac-tac-dung-phu-can-luu-y\/\">Dabigatran<\/a> \u0111\u01b0\u1ee3c so s\u00e1nh v\u1edbi warfarin ho\u1eb7c gi\u1ea3 d\u01b0\u1ee3c trong hai nghi\u00ean c\u1ee9u kh\u00e1c nhau. Trong c\u00e1c nghi\u00ean c\u1ee9u n\u00e0y, dabigatran kh\u00f4ng thua k\u00e9m <a href=\"https:\/\/www.vinmec.com\/vi\/thuoc\/warfarin-145\/\">warfarin<\/a> trong vi\u1ec7c ng\u0103n ng\u1eeba VTE t\u00e1i ph\u00e1t c\u00f3 tri\u1ec7u ch\u1ee9ng ho\u1eb7c t\u1eed vong li\u00ean quan \u0111\u1ebfn VTE, v\u00e0 hi\u1ec7u qu\u1ea3 h\u01a1n so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c \u0111\u1ec3 ph\u00f2ng ng\u1eeba VTE t\u00e1i ph\u00e1t c\u00f3 tri\u1ec7u ch\u1ee9ng ho\u1eb7c t\u1eed vong kh\u00f4ng r\u00f5 nguy\u00ean nh\u00e2n. T\u1ef7 l\u1ec7 xu\u1ea5t huy\u1ebft l\u1edbn l\u00e0 0.9% v\u1edbi dabigatran so v\u1edbi 1.8% v\u1edbi warfarin (HR 0.52, 95% CI 0.27-1.02).<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0<a href=\"https:\/\/www.vinmec.com\/vi\/thuoc\/rivaroxaban-69\/\">Rivaroxaban<\/a> \u0111\u01b0\u1ee3c so s\u00e1nh v\u1edbi gi\u1ea3 d\u01b0\u1ee3c ho\u1eb7c<a href=\"https:\/\/www.vinmec.com\/vi\/thong-tin-duoc\/su-dung-thuoc-toan\/nguoi-benh-can-luu-y-gi-khi-dung-aspirin\/\"> aspirin<\/a> trong hai nghi\u00ean c\u1ee9u kh\u00e1c nhau \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u00e3 ho\u00e0n th\u00e0nh 6-12 th\u00e1ng \u0111i\u1ec1u tr\u1ecb kh\u00e1ng \u0111\u00f4ng cho VTE l\u1ea7n \u0111\u1ea7u . \u0110i\u1ec1u tr\u1ecb b\u1eb1ng rivaroxaban [20 mg m\u1ed7i ng\u00e0y m\u1ed9t l\u1ea7n (o.d.)] gi\u1ea3m ~80% VTE t\u00e1i ph\u00e1t, v\u1edbi t\u1ef7 l\u1ec7 ch\u1ea3y m\u00e1u l\u1edbn ho\u1eb7c CRNM l\u00e0 6.0% so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c l\u00e0 1.2%. Rivaroxaban li\u1ec1u 20 ho\u1eb7c 10 mg o.d. \u0111\u01b0\u1ee3c so s\u00e1nh v\u1edbi aspirin (100 mg o.d.) \u1edf 3365 b\u1ec7nh nh\u00e2n. C\u1ea3 hai li\u1ec1u rivaroxaban \u0111\u1ec1u gi\u1ea3m VTE t\u00e1i ph\u00e1t c\u00f3 tri\u1ec7u ch\u1ee9ng g\u00e2y t\u1eed vong ho\u1eb7c kh\u00f4ng g\u00e2y t\u1eed vong b\u1eb1ng ~70% so v\u1edbi aspirin. Kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t c\u00f3 \u00fd ngh\u0129a th\u1ed1ng k\u00ea v\u1ec1 t\u1ef7 l\u1ec7 ch\u1ea3y m\u00e1u l\u1edbn ho\u1eb7c CRNM \u0111\u01b0\u1ee3c ghi nh\u1eadn \u1edf c\u1ea3 2 li\u1ec1u rivaroxaban v\u00e0 aspirin.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">B\u1ec7nh nh\u00e2n b\u1ecb VTE \u0111\u01b0\u1ee3c ch\u1ecdn ng\u1eabu nhi\u00ean \u0111\u1ec3 nh\u1eadn hai li\u1ec1u kh\u00e1c nhau c\u1ee7a <a href=\"https:\/\/www.vinmec.com\/vi\/thong-tin-duoc\/su-dung-thuoc-toan\/thuoc-apixaban-eliquis-cong-dung-cach-dung-va-cac-tac-dung-phu-can-luu-y\/\">apixaban<\/a> [2.5 ho\u1eb7c 5 mg <strong>hai l\u1ea7n m\u1ed9t ng\u00e0y<\/strong> (bis in die: b.i.d.)] ho\u1eb7c gi\u1ea3 d\u01b0\u1ee3c sau 6-12 th\u00e1ng ch\u1ed1ng \u0111\u00f4ng m\u00e1u ban \u0111\u1ea7u. C\u1ea3 hai li\u1ec1u apixaban \u0111\u1ec1u l\u00e0m gi\u1ea3m t\u1ef7 l\u1ec7 VTE t\u00e1i ph\u00e1t c\u00f3 tri\u1ec7u ch\u1ee9ng ho\u1eb7c t\u1eed vong do m\u1ecdi nguy\u00ean nh\u00e2n so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c v\u00e0 kh\u00f4ng lo ng\u1ea1i v\u1ec1 t\u00ednh an to\u00e0n. B\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 ch\u1ea3y m\u00e1u cao \u2013 d\u1ef1a tr\u00ean \u0111\u00e1nh gi\u00e1 c\u1ee7a \u0111i\u1ec1u tra vi\u00ean, ti\u1ec1n s\u1eed c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m \u2013 \u0111\u00e3 \u0111\u01b0\u1ee3c lo\u1ea1i kh\u1ecfi c\u00e1c nghi\u00ean c\u1ee9u k\u00e9o d\u00e0i \u0111\u01b0\u1ee3c \u0111\u1ec1 c\u1eadp \u1edf tr\u00ean; c\u00e1c nghi\u00ean c\u1ee9u v\u1ec1 ch\u1ed1ng \u0111\u00f4ng k\u00e9o d\u00e0i v\u1edbi VKA c\u0169ng t\u01b0\u01a1ng t\u1ef1. V\u00ec v\u1eady c\u1ea7n t\u00ednh nguy c\u01a1 ch\u1ea3y m\u00e1u cao tr\u01b0\u1edbc khi s\u1eed d\u1ee5ng kh\u00e1ng \u0111\u00f4ng k\u00e9o d\u00e0i v\u1edbi m\u1ed9t trong nh\u1eefng c\u00e1c li\u1ec7u tr\u00ecnh \u0111i\u1ec1u tr\u1ecb tr\u00ean.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0Trong m\u1ed9t nghi\u00ean c\u1ee9u ng\u1eabu nhi\u00ean kh\u00f4ng m\u00f9 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n nguy c\u01a1 cao m\u1eafc h\u1ed9i ch\u1ee9ng antiphospholipid (x\u00e9t nghi\u1ec7m b\u1ed9 ba d\u01b0\u01a1ng t\u00ednh g\u1ed3m <strong>ch\u1ea5t ch\u1ed1ng \u0111\u00f4ng lupus, anti cardiolipin v\u00e0 anti-b2-glycoprotein I<\/strong>), rivaroxaban c\u00f3 li\u00ean quan \u0111\u1ebfn t\u0103ng t\u1ef7 l\u1ec7 huy\u1ebft kh\u1ed1i v\u00e0 c\u00e1c bi\u1ebfn c\u1ed1 ch\u1ea3y m\u00e1u l\u1edbn so v\u1edbi warfarin (HR cho t\u1ed5ng k\u1ebft c\u1ee5c ch\u00ednh 6.7; 95% CI 1.5-30.5). Cho n\u00ean hi\u1ec7n nay, NOAC kh\u00f4ng ph\u1ea3i l\u00e0 m\u1ed9t thay th\u1ebf cho VKA cho b\u1ec7nh nh\u00e2n v\u1edbi h\u1ed9i ch\u1ee9ng antiphospholipid.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Trong hai th\u1eed nghi\u1ec7m v\u1edbi t\u1ed5ng s\u1ed1 1224 b\u1ec7nh nh\u00e2n, li\u1ec7u ph\u00e1p k\u00e9o d\u00e0i v\u1edbi aspirin (sau khi ch\u1ea5m d\u1ee9t thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng ti\u00eau chu\u1ea9n) li\u00ean quan \u0111\u1ebfn vi\u1ec7c gi\u1ea3m 30-35% nguy c\u01a1 t\u00e1i ph\u00e1t so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c. Tuy nhi\u00ean, g\u1ea7n \u0111\u00e2y, m\u1ed9t th\u1eed nghi\u1ec7m kh\u00e1c \u0111\u00e3 ch\u1ee9ng minh t\u00ednh \u01b0u vi\u1ec7t c\u1ee7a thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng rivaroxaban li\u1ec1u 20 ho\u1eb7c 10 mg o.d, so v\u1edbi aspirin \u0111\u1ed1i v\u1edbi d\u1ef1 ph\u00f2ng t\u00e1i ph\u00e1t VTE th\u1ee9 ph\u00e1t.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0M\u1ed9t nghi\u00ean c\u1ee9u ng\u1eabu nhi\u00ean, c\u00f3 \u0111\u1ed1i ch\u1ee9ng gi\u1ea3 d\u01b0\u1ee3c \u0111\u00e3 \u0111\u00e1nh gi\u00e1 <strong>sulodexide<\/strong> (2 x 250 \u0111\u01a1n v\u1ecb lipasemic vi\u00ean nang b.i.d.) \u0111\u1ec3 ng\u0103n ng\u1eeba t\u00e1i ph\u00e1t trong 615 b\u1ec7nh nh\u00e2n c\u00f3 VTE l\u1ea7n \u0111\u1ea7u m\u00e0 kh\u00f4ng c\u00f3 y\u1ebfu t\u1ed1 nguy c\u01a1 c\u00f3 th\u1ec3 x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c v\u00e0 \u0111\u00e3 ho\u00e0n th\u00e0nh 3- 12 th\u00e1ng \u0111i\u1ec1u tr\u1ecb thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng. Sulodexide l\u00e0m gi\u1ea3m nguy c\u01a1 t\u00e1i ph\u00e1t ~50% m\u00e0 kh\u00f4ng t\u0103ng r\u00f5 r\u1ec7t s\u1ed1 l\u1ea7n ch\u1ea3y m\u00e1u. Tuy nhi\u00ean, ch\u1ec9 c\u00f3 8% b\u1ec7nh nh\u00e2n VTE trong nghi\u00ean c\u1ee9u n\u00e0y l\u00e0 PE.<\/span><\/p>\n<h3><strong>2.4 Khuy\u1ebfn c\u00e1o v\u1ec1 li\u1ec7u tr\u00ecnh v\u00e0 th\u1eddi gian ch\u1ed1ng \u0111\u00f4ng sau thuy\u00ean t\u1eafc ph\u1ed5i \u1edf BN kh\u00f4ng c\u00f3 ung th\u01b0.<\/strong><\/h3>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"aligncenter size-full wp-image-32233\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Screenshot-623.png\" alt=\"lieu-trinh-chong-dong-va-thoi-gian-chong-dong-sau-thuyen-tac\" width=\"485\" height=\"582\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Screenshot-623.png 485w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Screenshot-623-250x300.png 250w\" sizes=\"(max-width: 485px) 100vw, 485px\" \/><\/p>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"aligncenter size-full wp-image-32234\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Screenshot-624.png\" alt=\"\" width=\"525\" height=\"329\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Screenshot-624.png 525w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Screenshot-624-300x188.png 300w\" sizes=\"(max-width: 525px) 100vw, 525px\" \/><\/p>\n<h3><strong>2.5 Qu\u1ea3n l\u00fd thuy\u00ean t\u1eafc ph\u1ed5i \u1edf b\u1ec7nh nh\u00e2n ung th\u01b0<\/strong><\/h3>\n<p><span style=\"font-weight: 400;\">\u00a0\u0110\u00e3 c\u00f3 5 RCT so s\u00e1nh LMWH v\u1edbi \u0111i\u1ec1u tr\u1ecb VTE c\u1ed5 \u0111i\u1ec3n (heparin theo sau l\u00e0 VKA) trong \u0111i\u1ec1u tr\u1ecb VTE \u1edf b\u1ec7nh nh\u00e2n c\u00f3 huy\u1ebft kh\u1ed1i li\u00ean quan \u0111\u1ebfn ung th\u01b0. N\u0103m 2003, \u0111\u00e3 c\u00f3 k\u1ebft qu\u1ea3 gi\u1ea3m c\u00f3 \u00fd ngh\u0129a VTE t\u00e1i ph\u00e1t khi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng LMWH so v\u1edbi \u0111i\u1ec1u tr\u1ecb (VKA) c\u1ed5 \u0111i\u1ec3n m\u00e0 kh\u00f4ng l\u00e0m t\u0103ng c\u00e1c bi\u1ebfn ch\u1ee9ng ch\u1ea3y m\u00e1u. Trong th\u1eed nghi\u1ec7m g\u1ea7n \u0111\u00e2y h\u01a1n, vi\u1ec7c s\u1eed d\u1ee5ng tinzaparin l\u00e2u d\u00e0i \u0111\u00e3 th\u1ea5t b\u1ea1i trong vi\u1ec7c gi\u1ea3m c\u00f3 \u00fd ngh\u0129a th\u1ed1ng k\u00ea \u0111\u1ed1i v\u1edbi t\u00e1i ph\u00e1t VTE chung so v\u1edbi \u0111i\u1ec1u tr\u1ecb c\u1ed5 \u0111i\u1ec3n (HR 0.65, 95% CI 0.41-1.03); tuy nhi\u00ean, t\u1ef7 l\u1ec7 VTE t\u00e1i ph\u00e1t chung trong nh\u00f3m ch\u1ee9ng th\u1ea5p h\u01a1n m\u1ee9c quan s\u00e1t tr\u01b0\u1edbc \u0111\u00e2y, c\u00f3 l\u1ebd l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a vi\u1ec7c l\u1ef1a ch\u1ecdn b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 huy\u1ebft kh\u1ed1i \u0111\u1eb7c hi\u1ec7u do ung th\u01b0 th\u1ea5p h\u01a1n. Nh\u00ecn chung, LMWH \u0111\u00e3 cho th\u1ea5y gi\u1ea3m 40% nguy c\u01a1 VTE t\u00e1i ph\u00e1t v\u1edbi nguy c\u01a1 bi\u1ebfn ch\u1ee9ng ch\u1ea3y m\u00e1u l\u1edbn t\u01b0\u01a1ng t\u1ef1 nh\u01b0 VKA. Do \u0111\u00f3, LMWH \u0111\u00e3 tr\u1edf th\u00e0nh \u0111i\u1ec1u tr\u1ecb ti\u00eau chu\u1ea9n. Tuy nhi\u00ean, c\u00e1c thu\u1ed1c n\u00e0y th\u01b0\u1eddng th\u00eam chi ph\u00ed v\u00e0 l\u00e0 g\u00e1nh n\u1eb7ng cho ng\u01b0\u1eddi b\u1ec7nh. Ngo\u00e0i ra, t\u1ef7 su\u1ea5t tuy\u1ec7t \u0111\u1ed1i c\u1ee7a VTE t\u00e1i ph\u00e1t trong khi \u0111i\u1ec1u tr\u1ecb v\u1edbi LMWH v\u1eabn \u1edf m\u1ee9c cao (7-9%) so v\u1edbi quan s\u00e1t th\u1ea5y \u1edf b\u1ec7nh nh\u00e2n VTE kh\u00f4ng ung th\u01b0 khi \u0111i\u1ec1u tr\u1ecb c\u1ed5 \u0111i\u1ec3n (1.5-3.0%).<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0NOAC c\u00f3 th\u1ec3 gi\u00fap \u0111i\u1ec1u tr\u1ecb VTE d\u1ec5 d\u00e0ng v\u00e0 thu\u1eadn ti\u1ec7n h\u01a1n \u1edf b\u1ec7nh nh\u00e2n ung th\u01b0, do s\u1eed d\u1ee5ng \u0111\u01b0\u1eddng u\u1ed1ng li\u1ec1u c\u1ed1 \u0111\u1ecbnh v\u00e0 chi ph\u00ed th\u1ea5p h\u01a1n so v\u1edbi LMWH. Tuy nhi\u00ean, ch\u1ec9 c\u00f3 3-9% b\u1ec7nh nh\u00e2n c\u00f3 ung th\u01b0 n\u1eb1m trong nghi\u00ean c\u1ee9u pha III \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb VTE v\u1edbi NOAC. M\u1ed9t th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean, kh\u00f4ng m\u00f9 so s\u00e1nh edoxaban v\u1edbi LMWH trong d\u1ef1 ph\u00f2ng th\u1ee9 ph\u00e1t VTE tr\u00ean 1050 b\u1ec7nh nh\u00e2n c\u00f3 huy\u1ebft kh\u1ed1i li\u00ean quan \u0111\u1ebfn ung th\u01b0 (ch\u1ee7 y\u1ebfu l\u00e0 PE c\u00f3 tri\u1ec7u ch\u1ee9ng ho\u1eb7c kh\u00f4ng tri\u1ec7u ch\u1ee9ng). Edoxaban (60 mg o.d., gi\u1ea3m xu\u1ed1ng 30 mg \u1edf nh\u1eefng ng\u01b0\u1eddi b\u1ecb suy th\u1eadn v\u1eeba, tr\u1ecdng l\u01b0\u1ee3ng c\u01a1 th\u1ec3 th\u1ea5p ho\u1eb7c c\u1ea7n d\u00f9ng \u0111\u1ed3ng th\u1eddi c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf m\u1ea1nh glycoprotein-P) \u0111\u01b0\u1ee3c b\u1eaft \u0111\u1ea7u sau 5 ng\u00e0y s\u1eed d\u1ee5ng LMWH v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u00e9o d\u00e0i trong \u22656 th\u00e1ng. Edoxaban kh\u00f4ng thua k\u00e9m dalteparin trong ph\u00f2ng ng\u1eeba t\u00e1i ph\u00e1t VTE ho\u1eb7c ch\u1ea3y m\u00e1u l\u1edbn trong 12 th\u00e1ng sau khi ph\u00e2n nh\u00f3m (HR 0.97, 95% CI 0.70-1.36). Ch\u1ea3y m\u00e1u l\u1edbn x\u1ea3y ra \u1edf 6.9% b\u1ec7nh nh\u00e2n \u1edf nh\u00e1nh edoxaban v\u00e0 4.0% \u1edf nh\u00e1nh dalteparin (s\u1ef1 kh\u00e1c bi\u1ec7t v\u1ec1 nguy c\u01a1 2.9 \u0111\u01a1n v\u1ecb ph\u1ea7n tr\u0103m, 95% CI 0.1-5.6). S\u1ef1 kh\u00e1c bi\u1ec7t n\u00e0y ch\u1ee7 y\u1ebfu b\u1edfi t\u1ef7 l\u1ec7 ch\u1ea3y m\u00e1u cao \u1edf b\u1ec7nh nh\u00e2n ung th\u01b0 \u0111\u01b0\u1eddng ti\u00eau h\u00f3a trong nh\u00f3m edoxaban. K\u1ebft qu\u1ea3 t\u01b0\u01a1ng t\u1ef1 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o b\u1edfi m\u1ed9t th\u1eed nghi\u1ec7m s\u01a1 b\u1ed9 ng\u1eabu nhi\u00ean kh\u00f4ng m\u00f9, so s\u00e1nh rivaroxaban v\u1edbi dalteparin \u1edf 406 b\u1ec7nh nh\u00e2n VTE v\u00e0 ung th\u01b0, 58% trong s\u1ed1 \u0111\u00f3 \u0111\u00e3 di c\u0103n. Rivaroxaban l\u00e0m gi\u1ea3m c\u00f3 \u00fd ngh\u0129a nguy c\u01a1 VTE t\u00e1i ph\u00e1t (HR 0.43, 95% CI 0.19-0.99). T\u1ef7 l\u1ec7 ch\u1ea3y m\u00e1u l\u1edbn t\u00edch l\u0169y 6 th\u00e1ng, ch\u1ee7 y\u1ebfu \u1edf \u0111\u01b0\u1eddng ti\u00eau h\u00f3a, rivaroxaban l\u00e0 6% (95% CI 3-11%) v\u00e0 dalteparin l\u00e0 4% (95% CI 2-8%), (HR 1.83, 95% CI 0.68-4.96). T\u1ef7 l\u1ec7 ch\u1ea3y m\u00e1u CRNM t\u01b0\u01a1ng \u1ee9ng l\u00e0 13% (95% CI 9-19%) v\u00e0 4% (95% CI 2-9%), (HR 3.76, 95% CI 1.63-8.69).<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0D\u1ef1a tr\u00ean c\u00e1c b\u1eb1ng ch\u1ee9ng hi\u1ec7n c\u00f3, nh\u01b0 \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 \u1edf tr\u00ean, b\u1ec7nh nh\u00e2n thuy\u00ean t\u1eafc ph\u1ed5i c\u1ea5p t\u00ednh v\u00e0 ung th\u01b0, \u0111\u1eb7c bi\u1ec7t l\u00e0 nh\u1eefng ng\u01b0\u1eddi b\u1ecb ung th\u01b0 \u0111\u01b0\u1eddng ti\u00eau h\u00f3a, n\u00ean \u0111\u01b0\u1ee3c khuy\u1ebfn kh\u00edch ti\u1ebfp t\u1ee5c LMWH t\u1eeb \u22653-6 th\u00e1ng. \u0110i\u1ec1u n\u00e0y c\u0169ng \u00e1p d\u1ee5ng cho nh\u1eefng b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1eddng u\u1ed1ng kh\u00f4ng kh\u1ea3 thi do c\u00e1c v\u1ea5n \u0111\u1ec1 v\u1ec1 nu\u1ed1t ho\u1eb7c h\u1ea5p thu v\u00e0 \u0111\u1ed1i v\u1edbi nh\u1eefng ng\u01b0\u1eddi m\u1eafc b\u1ec7nh suy th\u1eadn n\u1eb7ng. V\u1edbi nh\u1eefng tr\u01b0\u1eddng h\u1ee3p c\u00f2n l\u1ea1i, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n kh\u1ea3 n\u0103ng nguy c\u01a1 ch\u1ea3y m\u00e1u th\u1ea5p v\u00e0 kh\u00f4ng c\u00f3 kh\u1ed1i u \u0111\u01b0\u1eddng ti\u00eau h\u00f3a, s\u1ef1 l\u1ef1a ch\u1ecdn gi\u1eefa LMWH v\u00e0 edoxaban hay rivaroxaban s\u1ebd t\u00f9y thu\u1ed9c quy\u1ebft \u0111\u1ecbnh c\u1ee7a b\u00e1c s\u0129 v\u00e0 mong mu\u1ed1n c\u1ee7a b\u1ec7nh nh\u00e2n.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Do nguy c\u01a1 t\u00e1i ph\u00e1t cao, b\u1ec7nh nh\u00e2n ung th\u01b0 n\u00ean u\u1ed1ng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng v\u00f4 h\u1ea1n \u0111\u1ecbnh sau VTE l\u1ea7n \u0111\u1ea7u ti\u00ean. M\u1eb7c d\u00f9 b\u1eb1ng ch\u1ee9ng hi\u1ec7n c\u00f3 l\u00e0 h\u1ea1n ch\u1ebf, nh\u01b0ng c\u00f3 th\u1ec3 hi\u1ec3u r\u1eb1ng m\u1ed9t khi ung th\u01b0 \u0111\u01b0\u1ee3c ch\u1eefa kh\u1ecfi, nguy c\u01a1 t\u00e1i ph\u00e1t s\u1ebd gi\u1ea3m v\u00e0 c\u00f3 th\u1ec3 d\u1eebng kh\u00e1ng \u0111\u00f4ng. Tuy nhi\u00ean, \u0111\u1ecbnh ngh\u0129a v\u1ec1 b\u1ec7nh ung th\u01b0 \u0111\u00e3 h\u1ebft kh\u00f4ng ph\u1ea3i l\u00fac n\u00e0o c\u0169ng r\u00f5 r\u00e0ng. Nguy c\u01a1 t\u00e1i ph\u00e1t thuy\u00ean t\u1eafc ph\u1ed5i trong ung th\u01b0 \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 trong m\u1ed9t nghi\u00ean c\u1ee9u \u0111o\u00e0n h\u1ec7 tr\u00ean 543 b\u1ec7nh nh\u00e2n v\u00e0 \u0111\u01b0\u1ee3c x\u00e1c th\u1ef1c \u0111\u1ed9c l\u1eadp tr\u00ean 819 b\u1ec7nh nh\u00e2n. Thang \u0111i\u1ec3m \u0111\u1ec1 xu\u1ea5t \u0111\u1ec3 d\u1ef1 \u0111o\u00e1n nguy c\u01a1 t\u00e1i ph\u00e1t bao g\u1ed3m ung th\u01b0 v\u00fa (tr\u1eeb 1 \u0111i\u1ec3m), <a href=\"https:\/\/www.vinmec.com\/vi\/ung-buou-xa-tri\/thong-tin-suc-khoe\/dinh-nghia-cach-xac-dinh-giai-doan-ung-thu-theo-he-thong-tnm\/\">TNM<\/a> (Tumor Node Metastasis) giai \u0111o\u1ea1n I ho\u1eb7c II (tr\u1eeb 1 \u0111i\u1ec3m) c\u00f2n gi\u1edbi t\u00ednh n\u1eef, ung th\u01b0 ph\u1ed5i v\u00e0 VTE tr\u01b0\u1edbc \u0111\u00f3 (c\u1ed9ng 1 \u0111i\u1ec3m m\u1ed7i c\u00e1i). B\u1ec7nh nh\u00e2n c\u00f3 \u0111i\u1ec3m \u22640 c\u00f3 nguy c\u01a1 th\u1ea5p (\u22644.5%) v\u00e0 nh\u1eefng ng\u01b0\u1eddi c\u00f3 s\u1ed1 \u0111i\u1ec3m \u22651 c\u00f3 nguy c\u01a1 VTE t\u00e1i ph\u00e1t cao (\u226519%) trong 6 th\u00e1ng \u0111\u1ea7u.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Sau 3-6 th\u00e1ng \u0111\u1ea7u, \u0111i\u1ec1u tr\u1ecb ch\u1ed1ng \u0111\u00f4ng k\u00e9o d\u00e0i c\u00f3 th\u1ec3 bao g\u1ed3m ti\u1ebfp t\u1ee5c LMWH ho\u1eb7c chuy\u1ec3n sang thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng. Hai nghi\u00ean c\u1ee9u \u0111o\u00e0n h\u1ec7 \u0111\u00e3 \u0111\u00e1nh gi\u00e1 s\u1ef1 an to\u00e0n c\u1ee7a \u0111i\u1ec1u tr\u1ecb k\u00e9o d\u00e0i v\u1edbi LMWH (\u226412 th\u00e1ng) \u1edf b\u1ec7nh nh\u00e2n c\u00f3 huy\u1ebft kh\u1ed1i li\u00ean quan \u0111\u1ebfn ung th\u01b0. Trong c\u1ea3 hai nghi\u00ean c\u1ee9u, t\u1ef7 l\u1ec7 bi\u1ebfn ch\u1ee9ng ch\u1ea3y m\u00e1u cao h\u01a1n \u1edf nh\u1eefng th\u00e1ng \u0111\u1ea7u ti\u00ean v\u00e0 sau \u0111\u00f3 \u0111\u1ea1t \u0111\u1ebfn m\u1ed9t b\u00ecnh nguy\u00ean kh\u00f4ng thay \u0111\u1ed5i sau th\u00e1ng th\u1ee9 s\u00e1u. Trong tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng thuy\u1ebft ph\u1ee5c, quy\u1ebft \u0111\u1ecbnh ti\u1ebfp t\u1ee5c v\u1edbi LMWH ho\u1eb7c \u0111\u1ed5i sang VKA hay NOAC n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n t\u00f9y t\u1eebng tr\u01b0\u1eddng h\u1ee3p, sau khi c\u00e2n nh\u1eafc th\u00e0nh c\u00f4ng c\u1ee7a vi\u1ec7c \u0111i\u1ec1u tr\u1ecb ung th\u01b0, \u01b0\u1edbc t\u00ednh nguy c\u01a1 t\u00e1i ph\u00e1t VTE, nguy c\u01a1 ch\u1ea3y m\u00e1u, v\u00e0 mong mu\u1ed1n c\u1ee7a b\u1ec7nh nh\u00e2n. B\u1eaft bu\u1ed9c \u0111\u00e1nh gi\u00e1 l\u1ea1i \u0111\u1ecbnh k\u1ef3 t\u1ef7 l\u1ec7 nguy c\u01a1 \u2013 tr\u00ean \u2013 l\u1ee3i \u00edch c\u1ee7a \u0111i\u1ec1u tr\u1ecb kh\u00e1ng \u0111\u00f4ng k\u00e9o d\u00e0i.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\"><a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/chup-so-hoa-xoa-nen-va-dat-luoi-loc-tinh-mach-chu-duoi\/\">\u00a0L\u01b0\u1edbi l\u1ecdc t\u0129nh m\u1ea1ch<\/a> \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh ch\u1ee7 y\u1ebfu khi kh\u00f4ng th\u1ec3 d\u00f9ng kh\u00e1ng \u0111\u00f4ng do ch\u1ea3y m\u00e1u ti\u1ebfn tri\u1ec3n ho\u1eb7c nguy c\u01a1 ch\u1ea3y m\u00e1u qu\u00e1 m\u1ee9c. Tuy nhi\u00ean, nguy c\u01a1 t\u00e1i ph\u00e1t VTE khi kh\u00f4ng d\u00f9ng kh\u00e1ng \u0111\u00f4ng \u0111\u1eb7c bi\u1ec7t cao \u1edf b\u1ec7nh nh\u00e2n ung th\u01b0, n\u00ean vi\u1ec7c \u0111\u1eb7t l\u01b0\u1edbi l\u1ecdc kh\u00f4ng n\u00ean tr\u00ec ho\u00e3n vi\u1ec7c b\u1eaft \u0111\u1ea7u ch\u1ed1ng \u0111\u00f4ng ngay khi th\u1ea5y an to\u00e0n. Kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng h\u1ed7 tr\u1ee3 vi\u1ec7c s\u1eed d\u1ee5ng l\u01b0\u1edbi l\u1ecdc t\u0129nh m\u1ea1ch nh\u01b0 l\u00e0 m\u1ed9t bi\u1ec7n ph\u00e1p b\u1ed5 tr\u1ee3 cho \u0111i\u1ec1u tr\u1ecb ch\u1ed1ng \u0111\u00f4ng m\u00e1u \u1edf b\u1ec7nh nh\u00e2n ung th\u01b0.<\/span><\/p>\n<h3><strong>2.6 Khuy\u1ebfn c\u00e1o v\u1ec1 li\u1ec7u tr\u00ecnh v\u00e0 th\u1eddi gian ch\u1ed1ng \u0111\u00f4ng sau thuy\u00ean t\u1eafc ph\u1ed5i \u1edf BN m\u1eafc ung th\u01b0 \u0111ang ho\u1ea1t \u0111\u1ed9ng.<\/strong><\/h3>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"aligncenter size-full wp-image-32235\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Screenshot-625.png\" alt=\"lieu-trinh-chong-dong-sau-thuyen-tac-o-benh-nhan-ung-thu\" width=\"480\" height=\"338\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Screenshot-625.png 480w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/Screenshot-625-300x211.png 300w\" sizes=\"(max-width: 480px) 100vw, 480px\" \/><\/p>\n<p><span style=\"font-weight: 400;\">M\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u \u0111\u00e3 b\u00e1o c\u00e1o r\u1eb1ng m\u1ed9t t\u1ef7 l\u1ec7 b\u1ec7nh nh\u00e2n xu\u1ea5t hi\u1ec7n thuy\u00ean t\u1eafc ph\u1ed5i m\u00e0 kh\u00f4ng x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c y\u1ebfu t\u1ed1 nguy c\u01a1 n\u00e0o, l\u1ea1i ph\u00e1t tri\u1ec3n ung th\u01b0 trong n\u0103m \u0111\u1ea7u ti\u00ean sau ch\u1ea9n \u0111o\u00e1n. Do \u0111\u00f3, chi\u1ebfn l\u01b0\u1ee3c t\u1ed1i \u01b0u \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n s\u1edbm c\u00e1c b\u1ec7nh ung th\u01b0 \u1ea9n n\u00e0y \u0111\u00e3 \u0111\u01b0\u1ee3c t\u00ecm ki\u1ebfm. Hai th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean l\u1edbn \u0111\u00e3 th\u1ea5t b\u1ea1i trong vi\u1ec7c k\u1ebft lu\u1eadn<a href=\"https:\/\/www.vinmec.com\/vi\/chu-de\/ct-bung\/\"> CT to\u00e0n di\u1ec7n c\u1ee7a b\u1ee5ng<\/a> ho\u1eb7c <a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/gia-tri-ket-qua-khi-chup-cat-lop-phat-xa-positron\/\">ch\u1ee5p c\u1eaft l\u1edbp ph\u00e1t x\u1ea1 positron 18F deoxy-fluoro-glucose<\/a> c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n nhi\u1ec1u b\u1ec7nh ung th\u01b0 h\u01a1n s\u00e0ng l\u1ecdc gi\u1edbi h\u1ea1n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n VTE kh\u00f4ng c\u00f3 y\u1ebfu t\u1ed1 k\u00edch g\u1ee3i. V\u00ec th\u1ebf, d\u1ef1a tr\u00ean b\u1eb1ng ch\u1ee9ng hi\u1ec7n t\u1ea1i, vi\u1ec7c t\u00ecm ki\u1ebfm ung th\u01b0 \u1ea9n sau l\u1ea7n VTE c\u00f3 th\u1ec3 g\u00f3i g\u1ecdn l\u1ea1i trong h\u1ecfi b\u1ec7nh s\u1eed, kh\u00e1m l\u00e2m s\u00e0ng, x\u00e9t nghi\u1ec7m c\u01a1 b\u1ea3n v\u00e0 ch\u1ee5p X-quang ng\u1ef1c (n\u1ebfu kh\u00f4ng th\u1ef1c hi\u1ec7n CTPA \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n thuy\u00ean t\u1eafc ph\u1ed5i).<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0\u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n ung th\u01b0, khi thuy\u00ean t\u1eafc ph\u1ed5i t\u00ecnh c\u1edd ph\u00e1t hi\u1ec7n n\u00ean \u0111i\u1ec1u tr\u1ecb t\u01b0\u01a1ng t\u1ef1 nh\u01b0 thuy\u00ean t\u1eafc ph\u1ed5i c\u00f3 tri\u1ec7u ch\u1ee9ng, d\u00f9 l\u00e0 thuy\u00ean t\u1eafc m\u1ea1ch m\u00e1u ph\u00e2n th\u00f9y hay nh\u1eefng nh\u00e1nh g\u1ea7n h\u01a1n, \u0111a m\u1ea1ch m\u00e1u h\u1ea1 ph\u00e2n th\u00f9y ho\u1eb7c m\u1ed9t m\u1ea1ch m\u00e1u h\u1ea1 ph\u00e2n th\u00f9y \u0111\u01a1n \u0111\u1ed9c k\u1ebft h\u1ee3p v\u1edbi DVT.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Xem th\u00eam<\/strong>:<\/p>\n<p><a href=\"https:\/\/vinmecdr.com\/thuyen-tac-dong-mach-phoi-trong-thuc-hanh-lam-sang\/\">Thuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng (vinmecdr.com)<\/a><\/p>\n<p><a href=\"https:\/\/www.vinmec.com\/vi\/benh\/thuyen-tac-phoi-4442\/\">Thuy\u00ean t\u1eafc ph\u1ed5i: Nguy\u00ean nh\u00e2n, tri\u1ec7u ch\u1ee9ng, ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb | Vinmec<\/a><\/p>\n<p>Video \u0111\u1ec1 xu\u1ea5t:<\/p>\n<p><iframe loading=\"lazy\" title=\"Ung th\u01b0 ph\u00e1t tri\u1ec3n trong c\u01a1 th\u1ec3 nh\u01b0 th\u1ebf n\u00e0o?| BS Phan Tr\u00fac, BV Vinmec Times City\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/HA4__SCKOMM?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" allowfullscreen><\/iframe><\/p>\n<p>Ung th\u01b0 ph\u00e1t tri\u1ec3n trong c\u01a1 th\u1ec3 nh\u01b0 th\u1ebf n\u00e0o?<\/p>\n<p>T\u00e0i li\u1ec7u tham kh\u1ea3o:<\/p>\n<p><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/31473594\/\">2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC) &#8211; PubMed (nih.gov)<\/a><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Thuy\u00ean t\u1eafc ph\u1ed5i (PE)\u00a0 l\u00e0 t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00fd g\u00e2y ra do \u0111\u1ed9ng m\u1ea1ch trong ph\u1ed5i b\u1ecb t\u1eafc ngh\u1ebdn. B\u00ean c\u1ea1nh vi\u1ec7c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh l\u00fd c\u1ea5p t\u00ednh n\u00e0y ch\u00fang ta c\u1ea7n ph\u1ea3i t\u1ed1i \u01b0u vi\u1ec7c \u0111i\u1ec1u tr\u1ecb m\u1ea1n t\u00ednh v\u00e0 ph\u00f2ng ng\u1eeba t\u00e1i ph\u00e1t \u0111\u1ec3 ng\u0103n ch\u1eb7n t\u00ecnh tr\u1ea1ng b\u1ec7nh tr\u1edf [&hellip;]<\/p>\n","protected":false},"author":17,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[20,33],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>\u0110i\u1ec1u tr\u1ecb m\u1ea1n t\u00ednh \u1edf b\u1ec7nh nh\u00e2n thuy\u00ean t\u1eafc ph\u1ed5i - ESC 2019<\/title>\n<meta name=\"description\" content=\"Ch\u00fang ta c\u1ea7n ph\u1ea3i t\u1ed1i \u01b0u vi\u1ec7c \u0111i\u1ec1u tr\u1ecb m\u1ea1n t\u00ednh \u1edf b\u1ec7nh nh\u00e2n thuy\u00ean t\u1eafc ph\u1ed5i \u0111\u1ec3 ng\u0103n ch\u1eb7n t\u00ecnh tr\u1ea1ng b\u1ec7nh t\u00e1i ph\u00e1t tr\u1edf l\u1ea1i.\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"\u0110i\u1ec1u tr\u1ecb m\u1ea1n t\u00ednh \u1edf b\u1ec7nh nh\u00e2n thuy\u00ean t\u1eafc ph\u1ed5i - ESC 2019\" \/>\n<meta property=\"og:description\" content=\"Ch\u00fang ta c\u1ea7n ph\u1ea3i t\u1ed1i \u01b0u vi\u1ec7c \u0111i\u1ec1u tr\u1ecb m\u1ea1n t\u00ednh \u1edf b\u1ec7nh nh\u00e2n thuy\u00ean t\u1eafc ph\u1ed5i \u0111\u1ec3 ng\u0103n ch\u1eb7n t\u00ecnh tr\u1ea1ng b\u1ec7nh t\u00e1i ph\u00e1t tr\u1edf l\u1ea1i.\" \/>\n<meta property=\"og:url\" content=\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/07\/dieu-tri-man-tinh-o-benh-nhan-thuyen-tac-phoi-esc-2019\/\" \/>\n<meta property=\"og:site_name\" content=\"Vinmec\" \/>\n<meta property=\"article:published_time\" content=\"2023-05-07T06:31:36+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2023-05-18T03:10:21+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/aa.jpg\" \/>\n<meta name=\"author\" content=\"An Huynh Phan Ngoc\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"An Huynh Phan Ngoc\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"19 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/07\/dieu-tri-man-tinh-o-benh-nhan-thuyen-tac-phoi-esc-2019\/\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/07\/dieu-tri-man-tinh-o-benh-nhan-thuyen-tac-phoi-esc-2019\/\",\"name\":\"\u0110i\u1ec1u tr\u1ecb m\u1ea1n t\u00ednh \u1edf b\u1ec7nh nh\u00e2n thuy\u00ean t\u1eafc ph\u1ed5i - ESC 2019\",\"isPartOf\":{\"@id\":\"https:\/\/noithathoaphat.in\/ctv\/#website\"},\"datePublished\":\"2023-05-07T06:31:36+00:00\",\"dateModified\":\"2023-05-18T03:10:21+00:00\",\"author\":{\"@id\":\"https:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/106da77d14bd9697d17d477cee4fe3b8\"},\"description\":\"Ch\u00fang ta c\u1ea7n ph\u1ea3i t\u1ed1i \u01b0u vi\u1ec7c \u0111i\u1ec1u tr\u1ecb m\u1ea1n t\u00ednh \u1edf b\u1ec7nh nh\u00e2n thuy\u00ean t\u1eafc ph\u1ed5i \u0111\u1ec3 ng\u0103n ch\u1eb7n t\u00ecnh tr\u1ea1ng b\u1ec7nh t\u00e1i ph\u00e1t tr\u1edf l\u1ea1i.\",\"breadcrumb\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/07\/dieu-tri-man-tinh-o-benh-nhan-thuyen-tac-phoi-esc-2019\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/07\/dieu-tri-man-tinh-o-benh-nhan-thuyen-tac-phoi-esc-2019\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/07\/dieu-tri-man-tinh-o-benh-nhan-thuyen-tac-phoi-esc-2019\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/noithathoaphat.in\/ctv\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"\u0110i\u1ec1u tr\u1ecb m\u1ea1n t\u00ednh \u1edf b\u1ec7nh nh\u00e2n thuy\u00ean t\u1eafc ph\u1ed5i &#8211; 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