Venous thromboembolism prophylaxis may cause more harm than benefit: an evidence-based analysis of Canadian and international guidelines.
Venous thromboembolism prophylaxis may cause more harm than benefit: an evidence-based analysis of Canadian and international guidelines.
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DOI：
10.1186/s12959-018-0180-6
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发表时间：
2018
影响因子：
3.1
通讯作者：
Kotaska A
中科院分区：
文献类型：
--
作者：
Kotaska A
在住院患者的筛查研究中发现的大多数深静脉血栓仍然没有临床意义。基于这些研究的指南明显高估了临床静脉血栓栓塞症(VTE)的风险和肝素预防的益处。因此，2012年，美国胸科医师学会(ACCP)从其第9版抗血栓和溶栓治疗指南(AT9)中删除了筛查研究，并下调了建议。由于经济和知识上的利益冲突，第8版(AT8)的作者参与受到限制。然而，AT8的第一作者随后编写了一个“入门工具包”，广泛分发以帮助加拿大医院开发VTE协议。基于报告无症状VTE的筛查研究，它缺乏对低分子肝素(LMWH)益处或危害程度的估计，但建议几乎所有住院患者采取预防措施。大多数加拿大医院都实施了基于该试剂盒的指南。英国国家健康与护理卓越研究所和美国医疗研究与质量机构的指导方针建议采取类似的方法。然而，一项关键的证据回顾显示，大多数住院患者的临床VTE风险等于或低于LMWH的出血风险。大多数住院患者不应该接受低分子肝素治疗，除非随机试验显示利大于弊。建议住院患者自由使用低分子肝素预防的指南不是基于证据，应该进行严格的重新检查。本文的在线版本(10.1186/s12959-0180180-6)包含补充材料，可供授权用户使用。
A majority of deep vein thromboses identified in screening studies of hospitalized patients remain clinically insignificant. Guidelines based on these studies markedly overestimate the risk of clinical venous thromboembolism (VTE) and the benefit of heparin prophylaxis. Accordingly, in 2012, the American College of Chest Physicians (ACCP) removed screening studies from the 9th edition of its Antithrombotic and Thrombolytic Therapy guideline (AT9), and downgraded recommendations. Involvement of authors of the 8th edition (AT8) was restricted due to financial and intellectual conflicts of interest. However, the first author of AT8 subsequently wrote a “Getting Started Kit,” widely distributed to help Canadian hospitals develop VTE protocols. Based on screening studies reporting asymptomatic VTE, it lacks estimates of the magnitudes of benefit or harm from low molecular weight heparin (LMWH), yet advises prophylaxis in almost all hospitalized patients. Most Canadian hospitals have implemented guidelines based on this kit. Guidelines from the U. K National Institute for Health and Care Excellence and the U.S. Agency for Healthcare Research and Quality recommend a similar approach. However, a critical review of evidence reveals that most hospitalized patients have a risk of clinical VTE equal to or lower than the bleeding risk from LMWH. Most hospitalized patients should not receive LMWH until and unless randomized trials show more benefit than harm. Guidelines recommending liberal LMWH prophylaxis in hospitalized patients are not evidence based and should be critically re-examined. The online version of this article (10.1186/s12959-018-0180-6) contains supplementary material, which is available to authorized users.
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影响因子：
6.7
作者：
Chan, Noel C.;Stehouwer, Alexander C.;Eikelboom, John W.
通讯作者：
Eikelboom, John W.
DOI：
10.1111/j.1471-0528.2001.00198.x
发表时间：
2001-08-01
期刊：
BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY
影响因子：
--
作者：
Burrows, RF;Gan, ET;Burrows, EA
通讯作者：
Burrows, EA
DOI：
10.1001/jama.1992.03490170092032
发表时间：
1992-11-04
影响因子：
120.7
作者：
GUYATT, G
通讯作者：
GUYATT, G
影响因子：
9.6
作者：
Bates, Shannon M.;Greer, Ian A.;Vandvik, Per Olav
通讯作者：
Vandvik, Per Olav
影响因子：
158.5
作者：
Anderson, D. R.;Dunbar, M.;Vendittoli, P. -A.
通讯作者：
Vendittoli, P. -A.