Prevention of VTE in Nonsurgical Patients Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
Prevention of VTE in Nonsurgical 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.11-2296
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发表时间：
2012-02-01
期刊：
影响因子：
9.6
通讯作者：
Murad, M. Hassan
中科院分区：
文献类型：
--
作者：
Kahn, Susan R.;Lim, Wendy;Murad, M. Hassan
背景资料：本指南阐述了住院患者、癌症门诊患者、长期卧床患者、长途旅行者和无症状血栓形成倾向患者的静脉血栓栓塞预防。方法：本指南遵循《抗血栓治疗和预防血栓形成指南：抗血栓治疗和预防血栓形成的方法学》第9艾德版中描述的方法：美国胸科医师学会循证临床实践指南。结果：对于血栓形成风险增加的急性住院医疗患者，我们建议使用低分子量肝素（LMWH）进行抗凝血栓预防，低剂量普通肝素（LDUH）bid、LDUH tid或磺达肝癸钠（1B级），并建议不要将血栓预防的持续时间延长至患者制动或急性住院期间（2B级）。对于血栓形成风险较低的急性病住院患者，我们建议不要使用药物预防或机械预防（1B级）。对于出血或大出血高风险的血栓形成风险增加的急性病住院患者，我们建议使用分级加压袜（GCS）（2C级）或间歇性气动加压（IPC）（2C级）进行机械血栓预防。对于重症患者，我们建议使用LMWH或LDUH血栓预防（2C级）。对于出血或大出血高风险的危重患者，我们建议使用GCS和/或IPC进行机械血栓预防，至少直到出血风险降低（2C级）。在门诊癌症患者谁没有额外的危险因素静脉血栓栓塞，我们建议对常规预防与低分子肝素或LDUH（2B级），并建议对预防性使用维生素K拮抗剂（1B级）。结论：关于预防非手术患者的决定，应在考虑血栓形成和出血的危险因素，临床背景，患者的价值观和喜好。
Background: This guideline addressed VTE prevention in hospitalized medical patients, outpatients with cancer, the chronically immobilized, long-distance travelers, and those with asymptomatic thrombophilia.Methods: This guideline follows methods 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: For acutely ill hospitalized medical patients at increased risk of thrombosis, we recommend anticoagulant thromboprophylaxis with low-molecular-weight heparin (LMWH), low-dose unfractionated heparin (LDUH) bid, LDUH tid, or fondaparinux (Grade 1B) and suggest against extending the duration of thromboprophylaxis beyond the period of patient immobilization or acute hospital stay (Grade 2B). For acutely ill hospitalized medical patients at low risk of thrombosis, we recommend against the use of pharmacologic prophylaxis or mechanical prophylaxis (Grade 1B). For acutely ill hospitalized medical patients at increased risk of thrombosis who are bleeding or are at high risk for major bleeding, we suggest mechanical thromboprophylaxis with graduated compression stockings (GCS) (Grade 2C) or intermittent pneumatic compression (IPC) (Grade 2C). For critically ill patients, we suggest using LMWH or LDUH thromboprophylaxis (Grade 2C). For critically ill patients who are bleeding or are at high risk for major bleeding, we suggest mechanical thromboprophylaxis with GCS and/or IPC at least until the bleeding risk decreases (Grade 2C). In outpatients with cancer who have no additional risk factors for VTE we suggest against routine prophylaxis with LMWH or LDUH (Grade 2B) and recommend against the prophylactic use of vitamin K antagonists (Grade 1B).Conclusions: Decisions regarding prophylaxis in nonsurgical patients should be made after consideration of risk factors for both thrombosis and bleeding, clinical context, and patients' values and preferences.