Prevention of venous thromboembolism
Prevention of venous thromboembolism
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DOI：
10.1378/chest.126.3_suppl.338s
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发表时间：
2004-09-01
期刊：
影响因子：
9.6
通讯作者：
Ray, JG
中科院分区：
文献类型：
--
作者：
Geerts, WH;Pineo, GF;Ray, JG
本文讨论了静脉血栓栓塞（VTE）的预防，是第七届美国胸科医师学会抗血栓和溶栓治疗会议的一部分：循证指南。I级建议是强有力的，表明收益是否超过风险、负担和成本。2级表明个体患者的值可能导致不同的选择（对于分级的全面理解，参见Guyatt等人，CHEST 2004; 126：179 S-187 S）。本章的主要建议如下。我们不建议任何患者组（1A级）单独使用阿司匹林作为血栓预防。对于中度风险的普外科患者，我们建议使用低剂量普通肝素（LDUH）（5，000 U bid）或低分子量肝素（LMWH）[：53，400 U每日一次]（均为1A级）进行预防。对于高风险的普外科患者，我们建议使用LDUH（5，000 U tid）或LMWH（> 3，400 U每日）进行血栓预防[均为1A级]。对于具有多种风险因素的高风险普外科患者，我们建议将药理学方法（LDUH每日三次或LMWH，> 3，400 U每日）与使用渐进式压缩袜和/或间歇性气动压缩装置（1C+级）相结合。我们建议在所有接受重大妇科手术（1A级）或重大开放性泌尿外科手术的患者中使用血栓预防，我们建议每天两次或三次LDUH预防（1A级）。对于接受择期全髋关节或全膝关节置换术的患者，我们建议使用以下三种抗凝剂之一：LMWH、磺达肝素或调整剂量的维生素K拮抗剂（VKA）[国际标准化比值（INR）目标值，2.5;范围，2.0 - 3.0]（均为1A级）。对于接受髋部骨折手术（HFS）的患者，我们建议常规使用磺达肝癸钠（1A级）、LMWH（1C+级）、VKA（目标INR，2.5;范围，2.0 - 3.0）[2B级]或LDUH（1B级）。我们建议接受髋关节或膝关节置换术或HFS的患者接受至少10天的血栓预防（1A级）。我们建议所有至少有一个VTE危险因素的创伤患者接受血栓预防（1A级）。对于因充血性心力衰竭或严重呼吸系统疾病入院的急性内科患者，或卧床不起且有一种或多种其他风险因素的患者，我们建议使用LDUH（1A级）或LMWH（1A级）进行预防。我们建议，在进入重症监护室时，对所有患者进行VTE风险评估。因此，大多数患者应接受血栓预防（1A级）。
This article discusses the prevention of venous thromboembolism (VTE) and is part of the Seventh American College of Chest Physicians Conference on Antithrombotic and Thrombolytic Therapy: Evidence-Based Guidelines. Grade I recommendations are strong and indicate that the benefits do, or do not, outweigh risks, burden, and costs. Grade 2 suggests that individual patients' values may lead to different choices (for a full understanding of the grading see Guyatt et al, CHEST 2004; 126:179S-187S). Among the key recommendations in this chapter are the following. We recommend against the use of aspirin alone as thromboprophylaxis for any patient group (Grade 1A). For moderate-risk general surgery patients, we recommend prophylaxis with low-dose unfractionated heparin (LDUH) (5,000 U bid) or low-molecular-weight heparin (LMWH) [:5 3,400 U once daily] (both Grade 1A). For higher risk general surgery patients, we recommend thromboprophylaxis with LDUH (5,000 U tid) or LMWH (> 3,400 U daily) [both Grade 1A]. For high-risk general surgery patients with multiple risk factors, we recommend combining pharmacologic methods (LDUH three times daily or LMWH, > 3,400 U daily) with the use of graduated compression stockings, and/or intermittent pneumatic compression devices (Grade 1C+). We recommend that thromboprophylaxis be used in all patients undergoing major gynecologic surgery (Grade 1A) or major, open urologic procedures, and we recommend prophylaxis with LDUH two times or three times daily (Grade 1A). For patients undergoing elective total hip or knee arthroplasty, we recommend one of the following three anticoagulant agents: LMWH, fondaparinux, or adjusted-dose vitamin K antagonist (VKA) [international normalized ratio (INR) target, 2.5; range, 2.0 to 3.0] (all Grade 1A). For patients undergoing hip fracture surgery (HFS), we recommend the routine use of fondaparinux (Grade 1A), LMWH (Grade 1C+), VKA (target INR, 2.5; range, 2.0 to 3.0) [Grade 2B], or LDUH (Grade 1B). We recommend that patients undergoing hip or knee arthroplasty, or HFS receive thromboprophylaxis for at least 10 days (Grade 1A). We recommend that all trauma patients with at least one risk factor for VTE receive thromboprophylaxis (Grade 1A). in acutely ill medical patients who have been admitted to the hospital with congestive heart failure or severe respiratory disease, or who are confined to bed and have one or more additional risk factors, we recommend prophylaxis with LDUH (Grade 1A) or LMWH (Grade 1A). We recommend, on admission to the intensive care unit, all patients be assessed for their risk of VTE. Accordingly, most patients should receive thromboprophylaxis (Grade 1A).