American Society of Hematology 2018 guidelines for management of venous thromboembolism: prophylaxis for hospitalized and nonhospitalized medical patients
American Society of Hematology 2018 guidelines for management of venous thromboembolism: prophylaxis for hospitalized and nonhospitalized medical patients
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DOI：
10.1182/bloodadvances.2018022954
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发表时间：
2018-11-27
期刊：
影响因子：
7.5
通讯作者：
Wiercioch, Wojtek
中科院分区：
文献类型：
--
作者：
Schunemann, Holger J.;Cushman, Mary;Wiercioch, Wojtek
背景：静脉血栓栓塞（VTE）是第三大常见血管疾病。住院患者、长期护理居民、轻伤患者和长途旅行者的风险增加。 目的：美国血液学会 (ASH) 的这些循证指南旨在支持患者、临床医生和其他人做出预防这些群体 VTE 的决策。方法：ASH 形成了一个平衡的多学科指南小组，以最大程度地减少利益冲突带来的潜在偏差。麦克马斯特大学 GRADE 中心支持指南制定过程，包括更新或进行系统证据审查。该小组根据临床问题和结果对临床医生和成年患者的重要性对临床问题和结果进行优先排序。采用建议分级评估、制定和评估方法来评估证据并提出建议，并接受公众意见。结果：专家组就针对急症和危重住院患者、长期护理机构人员、轻伤门诊患者和长途旅行者的 19 项建议达成一致。结论：强烈建议包括对出血风险可接受的急症或危重住院患者提供药物 VTE 预防，在出血风险低于预期时使用机械预防。不可接受，反对在住院期间直接使用口服抗凝剂，并反对出院后扩大药物预防。有条件的建议包括不要对长期护理患者或有轻微 VTE 危险因素的门诊患者常规使用 VTE 预防。专家组有条件地建议长途旅行者仅在 VTE 风险较高时才使用分级压力袜或低分子肝素。
Background: Venous thromboembolism (VTE) is the third most common vascular disease. Medical inpatients, long-term care residents, persons with minor injuries, and long-distance travelers are at increased risk.Objective: These evidence-based guidelines from the American Society of Hematology (ASH) intend to support patients, clinicians, and others in decisions about preventing VTE in these groups.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 adult patients. The Grading of Recommendations Assessment, Development and Evaluation approach was used to assess evidence and make recommendations, which were subject to public comment.Result: The panel agreed on 19 recommendations for acutely ill and critically ill medical inpatients, people in long-term care facilities, outpatients with minor injuries, and long-distance travelers.Conclusion: Strong recommendations included provision of pharmacological VTE prophylaxis in acutely or critically ill inpatients at acceptable bleeding risk, use of mechanical prophylaxis when bleeding risk is unacceptable, against the use of direct oral anticoagulants during hospitalization, and against extending pharmacological prophylaxis after hospital discharge. Conditional recommendations included not to use VTE prophylaxis routinely in long-term care patients or outpatients with minor VTE risk factors. The panel conditionally recommended use of graduated compression stockings or low-molecular-weight heparin in long-distance travelers only if they are at high risk for VTE.