Prevention of VTE in Orthopedic Surgery Patients Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
Prevention of VTE in Orthopedic Surgery 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.11-2404
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发表时间：
2012-02-01
期刊：
影响因子：
9.6
通讯作者：
Colwell, Clifford W., Jr.
中科院分区：
文献类型：
--
作者：
Falck-Ytter, Yngve;Francis, Charles W.;Colwell, Clifford W., Jr.
背景：静脉血栓栓塞是一种严重的并发症，但在骨科大手术后逐渐减少。本指南侧重于减少术后肺栓塞和DVT的最佳预防。方法：本指南的方法遵循本增补中的抗血栓治疗和血栓预防指南的开发方法学：抗血栓治疗和血栓预防，第9版艾德：美国胸科医师学会循证临床实践指南。结果：在接受大型骨科手术的患者中，我们建议使用以下其中一种而不是不使用抗血栓预防：低分子量肝素;磺达肝素;达比加群、阿哌沙班、利伐沙班（全髋关节置换术或全膝关节置换术，但不包括髋部骨折手术）;低剂量普通肝素;调整剂量的维生素K拮抗剂;阿司匹林（均为1B级）;或间歇性气动加压装置（IPCD）（1C级）至少10至14天。我们建议使用低分子量肝素优先于我们推荐的其他药物作为替代（2C/2B级），对于接受药物预防的患者，我们建议在住院期间增加IPCD（2C级）。我们建议将血栓预防延长至35天（2B级）。在出血风险增加的患者中，我们建议使用IPCD或不进行预防（2C级）。对于拒绝注射的患者，我们建议使用阿哌沙班或达比加群（均为1B级）。我们建议对于同时存在药物和机械血栓预防禁忌症（2C级）的患者，不要将下腔静脉滤器置入用于一级预防。我们建议不要在出院前进行多普勒（或双功）超声检查（1B级）。对于需要下肢制动的孤立性下肢损伤患者，我们建议不进行血栓预防（2B级）。对于接受膝关节镜检查的患者没有静脉血栓栓塞的历史，我们建议没有血栓预防（2B级）。结论：最佳的策略，主要骨科手术后血栓预防包括药物和机械的方法。
Background: VTE is a serious, but decreasing complication following major orthopedic surgery. This guideline focuses on optimal prophylaxis to reduce postoperative pulmonary embolism and DVT.Methods: The methods of this guideline follow those 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: In patients undergoing major orthopedic surgery, we recommend the use of one of the following rather than no antithrombotic prophylaxis: low-molecular-weight heparin; fondaparinux; dabigatran, apixaban, rivaroxaban (total hip arthroplasty or total knee arthroplasty but not hip fracture surgery); low-dose unfractionated heparin; adjusted-dose vitamin K antagonist; aspirin (all Grade 1B); or an intermittent pneumatic compression device (IPCD) (Grade 1C) for a minimum of 10 to 14 days. We suggest the use of low-molecular-weight heparin in preference to the other agents we have recommended as alternatives (Grade 2C/2B), and in patients receiving pharmacologic prophylaxis, we suggest adding an IPCD during the hospital stay (Grade 2C). We suggest extending thromboprophylaxis for up to 35 days (Grade 2B). In patients at increased bleeding risk, we suggest an IPCD or no prophylaxis (Grade 2C). In patients who decline injections, we recommend using apixaban or dabigatran (all Grade 1B). We suggest against using inferior vena cava filter placement for primary prevention in patients with contraindications to both pharmacologic and mechanical thromboprophylaxis (Grade 2C). We recommend against Doppler (or duplex) ultrasonography screening before hospital discharge (Grade 1B). For patients with isolated low-erextremity injuries requiring leg immobilization, we suggest no thromboprophylaxis (Grade 2B). For patients undergoing knee arthroscopy without a history of VTE, we suggest no thromboprophylaxis (Grade 2B).Conclusions: Optimal strategies for thromboprophylaxis after major orthopedic surgery include pharmacologic and mechanical approaches.