Prevention, Diagnosis, and Treatment of VTE in Patients With Coronavirus Disease 2019 CHEST Guideline and Expert Panel Report
Prevention, Diagnosis, and Treatment of VTE in Patients With Coronavirus Disease 2019 CHEST Guideline and Expert Panel Report
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DOI：
10.1016/j.chest.2020.05.559
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发表时间：
2020-09-01
期刊：
影响因子：
9.6
通讯作者：
Wells, Philip
中科院分区：
文献类型：
--
作者：
Moores, Lisa K.;Tritschler, Tobias;Wells, Philip
背景：新出现的证据表明，2019年严重冠状病毒病（COVID-19）可能并发明显的凝血功能障碍，这可能以微血栓形成和静脉血栓栓塞的形式表现出来。这种认识导致了对静脉血栓栓塞的预防、诊断和治疗的实用指导的迫切需要。方法：一组经批准的小组成员通过使用PICO（人群、干预、比较者、结果）格式制定关键临床问题，解决有关COVID-19患者静脉血栓栓塞的预防、诊断和治疗的紧急临床问题。系统地检索MEDLINE（通过PubMed或Ovid）、Embase和Cochrane Controlled Register of Trials相关文献，筛选参考文献纳入。使用经过验证的评估工具对支持每项建议的证据水平进行分级。当证据不存在时，使用改进的德尔菲过程根据共识制定指南。结果：基于13个人口、干预、比较、结局问题的文献的系统回顾和批判性分析产生了22个陈述。在COVID-19人群中存在的证据很少。因此，该小组利用专家共识和现有的循证准则来起草指导声明。结论：关于COVID-19患者静脉血栓栓塞预防、诊断和治疗的最佳策略的证据很少，但正在迅速发展。
BACKGROUND: Emerging evidence shows that severe coronavirus disease 2019 (COVID-19) can be complicated by a significant coagulopathy, that likely manifests in the form of both microthrombosis and VTE. This recognition has led to the urgent need for practical guidance regarding prevention, diagnosis, and treatment of VTE.METHODS: A group of approved panelists developed key clinical questions by using the PICO (Population, Intervention, Comparator, Outcome) format that addressed urgent clinical questions regarding the prevention, diagnosis, and treatment of VTE in patients with COVID-19. MEDLINE (via PubMed or Ovid), Embase, and Cochrane Controlled Register of Trials were systematically searched for relevant literature, and references were screened for inclusion. Validated evaluation tools were used to grade the level of evidence to support each recommendation. When evidence did not exist, guidance was developed based on consensus using the modified Delphi process.RESULTS: The systematic review and critical analysis of the literature based on 13 Population, Intervention, Comparator, Outcome questions resulted in 22 statements. Very little evidence exists in the COVID-19 population. The panel thus used expert consensus and existing evidence-based guidelines to craft the guidance statements.CONCLUSIONS: The evidence on the optimal strategies to prevent, diagnose, and treat VTE in patients with COVID-19 is sparse but rapidly evolving.