Preventing Venous Thromboembolic Disease in Patients Undergoing Elective Hip and Knee Arthroplasty
Preventing Venous Thromboembolic Disease in Patients Undergoing Elective Hip and Knee Arthroplasty
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DOI：
10.5435/00124635-201112000-00007
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发表时间：
2011-12-01
影响因子：
3.2
通讯作者：
Sluka, Patrick
中科院分区：
文献类型：
--
作者：
Mont, Michael A.;Jacobs, Joshua J.;Sluka, Patrick
这一指导方针取代了2007年关于类似主题的先前指导方针。该工作组评估了有关患者筛查、危险因素评估、静脉血栓栓塞病(VTED)预防性治疗以及术后动员、神经轴剂和腔静脉滤器的使用等方面的现有文献。该小组建议对既往有静脉血栓栓塞症的患者进行进一步评估，但不包括其他潜在的危险因素。应评估患者是否有已知的出血性疾病，如血友病，以及是否存在活动性肝病。未增加VTED或出血风险的患者应接受药物预防和机械压迫装置以预防VTED。该组织没有推荐特定的药理药物和/或机械装置。工作组一致建议，择期髋关节和膝关节置换术后的患者应尽早活动。使用神经轴麻可以帮助减少失血，但没有发现影响VTED的发生。下腔静脉滤器是否可以预防化学预防和/或已知VTED禁忌症患者的肺栓塞，尚无明确证据。
This guideline supersedes a prior one from 2007 on a similar topic. The work group evaluated the available literature concerning various aspects of patient screening, risk factor assessment, and prophylactic treatment against venous thromboembolic disease (VTED), as well as the use of postoperative mobilization, neuraxial agents, and vena cava filters. The group recommended further assessment of patients who have had a previous venous thromboembolism but not for other potential risk factors. Patients should be assessed for known bleeding disorders, such as hemophilia, and for the presence of active liver disease. Patients who are not at elevated risk of VTED or for bleeding should receive pharmacologic prophylaxis and mechanical compressive devices for the prevention of VTED. The group did not recommend specific pharmacologic agents and/or mechanical devices. The work group recommends, by consensus opinion, early mobilization for patients following elective hip and knee arthroplasty. The use of neuraxial anesthesia can help limit blood loss but was not found to affect the occurrence of VTED. No clear evidence was established regarding whether inferior vena cava filters can prevent pulmonary embolism in patients who have a contraindication to chemoprophylaxis and/or known VTED.