Prevention of VTE in Nonorthopedic Surgical Patients Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
Prevention of VTE in Nonorthopedic Surgical Patients Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
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DOI：
10.1378/chest.11-2297
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发表时间：
2012-02-01
期刊：
影响因子：
9.6
通讯作者：
Samama, Charles M.
中科院分区：
文献类型：
--
作者：
Gould, Michael K.;Garcia, David A.;Samama, Charles M.
背景资料：静脉血栓栓塞是一种常见的原因，可预防的死亡在外科patients.Methods：我们制定了建议，血栓预防在非骨科手术患者使用系统的方法中所描述的抗血栓治疗和预防血栓指南的发展方法。抗血栓治疗和预防血栓形成，第9版艾德：美国胸科医师学会循证临床实践指南在此supplement.Results：我们描述了几种替代方案，用于分层一般和腹盆腔手术患者的VTE风险。当静脉血栓栓塞的风险非常低（0.5%）时，我们建议除早期amplification外，不使用特定的药物（1B级）或机械（2C级）预防。对于VTE风险较低的患者（类似于1.5%），我们建议机械预防，最好是间歇性气动压缩（IPC），而不是无预防（2C级）。对于VTE中度风险（约3%）但大出血并发症风险不高的患者，我们建议使用低分子量肝素（LMWH）（2B级）、低剂量普通肝素（2B级）或机械预防性IPC（2C级）。对于VTE高风险（约6%）但大出血并发症风险不高的患者，我们建议使用LMWH（1B级）或低剂量普通肝素（1B级）进行药物预防，而不是不进行预防。在这些患者中，我们建议在药物预防（2C级）的基础上增加弹力袜或IPC的机械预防。对于因癌症接受腹部或盆腔手术的VTE高危患者，我们建议在短期预防（1B级）基础上使用LMWH进行延长持续时间的术后药物预防（4周）。对于中至高风险的VTE患者，即大出血并发症的高风险患者或认为出血后果特别严重的患者，我们建议使用机械预防，最好是IPC，而不是无预防，直到出血风险降低，可以开始药物预防（2C级）。对于所有风险组的患者，我们建议不使用下腔静脉滤器进行一级VTE预防（2C级），并且不应进行静脉压迫超声监测（2C级）。我们制定了类似的建议，为其他nonorthogonal surgery population.Conclusions：最佳血栓预防在nonorthogonal surgery患者将考虑静脉血栓栓塞和出血并发症的风险，以及个人患者的价值和喜好。
Background: VTE is a common cause of preventable death in surgical patients.Methods: We developed recommendations for thromboprophylaxis in nonorthopedic surgical patients by using systematic methods as described in Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines. Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines in this supplement.Results: We describe several alternatives for stratifying the risk of VTE in general and abdominal-pelvic surgical patients. When the risk for VTE is very low (, 0.5%), we recommend that no specific pharmacologic (Grade 1B) or mechanical (Grade 2C) prophylaxis be used other than early ambulation. For patients at low risk for VTE (similar to 1.5%), we suggest mechanical prophylaxis, preferably with intermittent pneumatic compression (IPC), over no prophylaxis (Grade 2C). For patients at moderate risk for VTE (similar to 3%) who are not at high risk for major bleeding complications, we suggest low-molecular-weight heparin (LMWH) (Grade 2B), low-dose unfractionated heparin (Grade 2B), or mechanical prophylaxis with IPC (Grade 2C) over no prophylaxis. For patients at high risk for VTE (similar to 6%) who are not at high risk for major bleeding complications, we recommend pharmacologic prophylaxis with LMWH (Grade 1B) or low-dose unfractionated heparin (Grade 1B) over no prophylaxis. In these patients, we suggest adding mechanical prophylaxis with elastic stockings or IPC to pharmacologic prophylaxis (Grade 2C). For patients at high risk for VTE undergoing abdominal or pelvic surgery for cancer, we recommend extended-duration, postoperative, pharmacologic prophylaxis (4 weeks) with LMWH over limited-duration prophylaxis (Grade 1B). For patients at moderate to high risk for VTE who are at high risk for major bleeding complications or those in whom the consequences of bleeding are believed to be particularly severe, we suggest use of mechanical prophylaxis, preferably with IPC, over no prophylaxis until the risk of bleeding diminishes and pharmacologic prophylaxis may be initiated (Grade 2C). For patients in all risk groups, we suggest that an inferior vena cava filter not be used for primary VTE prevention (Grade 2C) and that surveillance with venous compression ultrasonography should not be performed (Grade 2C). We developed similar recommendations for other nonorthopedic surgical populations.Conclusions: Optimal thromboprophylaxis in nonorthopedic surgical patients will consider the risks of VTE and bleeding complications as well as the values and preferences of individual patients.