Antithrombotic Therapy for VTE Disease CHEST Guideline and Expert Panel Report
Antithrombotic Therapy for VTE Disease CHEST Guideline and Expert Panel Report
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DOI：
10.1016/j.chest.2015.11.026
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发表时间：
2016-02-01
期刊：
影响因子：
9.6
通讯作者：
Moores, Lisa
中科院分区：
文献类型：
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作者：
Kearon, Clive;Akl, Elie A.;Moores, Lisa
背景技术背景：我们更新了第9版指南中的12个主题的建议，并提出了3个新的主题。方法：我们根据高（A级）、中（B级）和低（C级）质量证据生成强（1级）和弱（2级）建议。结果：对于VTE和非癌症，我们建议达比加群作为长期抗凝治疗（2B级）、利伐沙班（2B级）、阿哌沙班（2B级）或依度沙班（2B级）优于维生素K拮抗剂（VKA）治疗，并建议VKA治疗优于低分子量肝素（LMWH; 2C级）。对于VTE和癌症，我们建议LMWH优于VKA（2B级）、达比加群（2C级）、利伐沙班（2C级）、阿哌沙班（2C级）或依度沙班（2C级）。我们没有改变关于谁应该在3个月时停止抗凝治疗或接受延长治疗的建议。对于使用抗凝剂治疗的VTE，我们建议不要使用下腔静脉滤器（1B级）。对于DVT，我们建议不要常规使用压缩袜来预防PTS（2B级）。对于亚段肺栓塞且无近端DVT的患者，我们建议在VTE复发风险较低（2C级）的情况下进行抗凝治疗的临床监测，在风险较高（2C级）的情况下进行抗凝治疗的临床监测。我们建议对肺栓塞伴低血压（2B级）的患者进行溶栓治疗，而全身治疗优于导管溶栓（2C级）。对于非LMWH抗凝剂治疗的复发性VTE，我们建议使用LMWH（2C级）;对于LMWH治疗的复发性VTE，我们建议增加LMWH剂量（2C级）。结论：在30份声明中包含的54项建议中，有20项是强有力的，没有一项是基于高质量的证据，强调需要进一步研究。
BACKGROUND: We update recommendations on 12 topics that were in the 9th edition of these guidelines, and address 3 new topics.METHODS: We generate strong (Grade 1) and weak (Grade 2) recommendations based on high-(Grade A), moderate-(Grade B), and low-(Grade C) quality evidence.RESULTS: For VTE and no cancer, as long-term anticoagulant therapy, we suggest dabigatran (Grade 2B), rivaroxaban (Grade 2B), apixaban (Grade 2B), or edoxaban (Grade 2B) over vitamin K antagonist (VKA) therapy, and suggest VKA therapy over low-molecular-weight heparin (LMWH; Grade 2C). For VTE and cancer, we suggest LMWH over VKA (Grade 2B), dabigatran (Grade 2C), rivaroxaban (Grade 2C), apixaban (Grade 2C), or edoxaban (Grade 2C). We have not changed recommendations for who should stop anticoagulation at 3 months or receive extended therapy. For VTE treated with anticoagulants, we recommend against an inferior vena cava filter (Grade 1B). For DVT, we suggest not using compression stockings routinely to prevent PTS (Grade 2B). For subsegmental pulmonary embolism and no proximal DVT, we suggest clinical surveillance over anticoagulation with a low risk of recurrent VTE (Grade 2C), and anticoagulation over clinical surveillance with a high risk (Grade 2C). We suggest thrombolytic therapy for pulmonary embolism with hypotension (Grade 2B), and systemic therapy over catheter-directed thrombolysis (Grade 2C). For recurrent VTE on a non-LMWH anticoagulant, we suggest LMWH (Grade 2C); for recurrent VTE on LMWH, we suggest increasing the LMWH dose (Grade 2C).CONCLUSIONS: Of 54 recommendations included in the 30 statements, 20 were strong and none was based on high-quality evidence, highlighting the need for further research.