American Society of Hematology 2018 guidelines for management of venous thromboembolism: venous thromboembolism in the context of pregnancy
American Society of Hematology 2018 guidelines for management of venous thromboembolism: venous thromboembolism in the context of pregnancy
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DOI：
10.1182/bloodadvances.2018024802
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发表时间：
2018-11-27
期刊：
影响因子：
7.5
通讯作者：
Rochwerg, Bram
中科院分区：
文献类型：
--
作者：
Bates, Shannon M.;Rajasekhar, Anita;Rochwerg, Bram
背景：静脉血栓栓塞（VTE）的并发症与每1000例分娩中的1.2例相似。尽管这些低的绝对风险，妊娠相关的静脉血栓栓塞是孕产妇发病率和mortals.Objective的主要原因：这些循证指南的美国血液学学会（ASH）的目的是支持患者，临床医生和其他人在决定有关的预防和管理妊娠相关的静脉血栓栓塞栓塞（VTE.Methods）：ASH形成了一个多学科的指南小组平衡，以尽量减少潜在的偏见，从利益冲突。麦克马斯特大学GRADE中心支持指南的制定过程，包括更新或进行系统的证据审查。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。分级的建议评估，发展和评价（GRADE）的方法被用来评估证据，并提出recommends.Results：该小组同意31条建议，有关治疗静脉血栓栓塞和浅静脉血栓形成，诊断静脉血栓栓塞，血栓prophylaxis.Conclusions：有一个强烈的建议，低分子量肝素（LWMH）在普通肝素急性静脉血栓栓塞。大多数建议是有条件的，包括每天两次或每天一次LMWH给药治疗急性VTE和低风险急性VTE住院期间的初始门诊治疗，以及常规抗Xa因子（FXa）监测以指导LMWH给药治疗VTE。强烈建议（证据确定性低）有无诱因或妊娠相关性VTE病史的产前抗凝剂预防，有条件建议既往VTE与消退的非激素激发风险因素相关的产前抗凝剂预防。
Background: Venous thromboembolism (VTE) complicates similar to 1.2 of every 1000 deliveries. Despite these low absolute risks, pregnancy-associated VTE is a leading cause of maternal morbidity and mortality.Objective: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians and others in decisions about the prevention and management of pregnancy-associated VTE.Methods: ASH formed a multidisciplinary guideline panel 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. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence and make recommendations.Results: The panel agreed on 31 recommendations related to the treatment of VTE and superficial vein thrombosis, diagnosis of VTE, and thrombosis prophylaxis.Conclusions: There was a strong recommendation for low-molecular-weight heparin (LWMH) over unfractionated heparin for acute VTE. Most recommendations were conditional, including those for either twice-per-day or once-per-day LMWH dosing for the treatment of acute VTE and initial outpatient therapy over hospital admission with low-risk acute VTE, as well as against routine anti-factor Xa (FXa) monitoring to guide dosing with LMWH for VTE treatment. There was a strong recommendation (low certainty in evidence) for antepartum anticoagulant prophylaxis with a history of unprovoked or hormonally associated VTE and a conditional recommendation against antepartum anticoagulant prophylaxis with prior VTE associated with a resolved nonhormonal provoking risk factor.