American Society of Hematology 2018 Guidelines for management of venous thromboembolism: treatment of pediatric venous thromboembolism
American Society of Hematology 2018 Guidelines for management of venous thromboembolism: treatment of pediatric venous thromboembolism
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DOI：
10.1182/bloodadvances.2018024786
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发表时间：
2018-11-27
期刊：
影响因子：
7.5
通讯作者：
Vesely, Sara K.
中科院分区：
文献类型：
--
作者：
Monagle, Paul;Cuello, Carlos A.;Vesely, Sara K.
背景资料：尽管在三级医疗机构中儿科患者的静脉血栓栓塞（VTE）的发病率不断增加，但相对较少的儿科医生具有抗血栓干预的经验。目的：美国血液学学会（ASH）的这些指南基于现有的最佳证据，旨在支持患者、临床医生和其他医疗保健专业人员关于儿科VTE管理的决策。ASH成立了一个多学科指南小组，包括2名患者代表，并进行了平衡，以最大限度地减少利益冲突的潜在偏倚。麦克马斯特大学GRADE中心支持指南制定过程，包括更新或进行系统性证据审查（截至2017年4月）。专家组根据临床问题和结果对临床医生和患者的重要性对其进行优先排序。该小组使用的建议评估，开发和评价（GRADE）的方法，包括GRADE证据决策框架，评估证据，并提出建议，这是受公众comment.Results：该小组同意了30项建议，包括有症状和无症状的深静脉血栓形成，特别关注中心静脉通路装置相关的静脉血栓栓塞的管理。该小组还讨论了肾和门静脉血栓形成，脑窦静脉血栓形成，和纯合子蛋白C deficiency.Conclusion：虽然该小组提供了许多建议，需要更多的研究。重点包括了解无症状血栓形成的自然史，确定亚组边界，使儿童的风险分层，治疗升级，并适当研究新的抗凝剂在儿童。
Background: Despite an increasing incidence of venous thromboembolism (VTE) in pediatric patients in tertiary care settings, relatively few pediatric physicians have experience with antithrombotic interventions.Objective: These guidelines of the American Society of Hematology (ASH), based on the best available evidence, are intended to support patients, clinicians, and other health care professionals in their decisions about management of pediatric VTE.Methods: ASH formed a multidisciplinary guideline panel that included 2 patient representatives and was balanced to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline-development process, including updating or performing systematic evidence reviews (up to April of 2017). The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The panel used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, including GRADE Evidence-to-Decision frameworks, to assess evidence and make recommendations, which were subject to public comment.Results: The panel agreed on 30 recommendations, covering symptomatic and asymptomatic deep vein thrombosis, with specific focus on management of central venous access device-associated VTE. The panel also addressed renal and portal vein thrombosis, cerebral sino venous thrombosis, and homozygous protein C deficiency.Conclusion: Although the panel offered many recommendations, additional research is required. Priorities include understanding the natural history of asymptomatic thrombosis, determining subgroup boundaries that enable risk stratification of children for escalation of treatment, and appropriate study of newer anticoagulant agents in children.