American Association of Orthopedic Surgeons and American College of Chest Physicians Guidelines for Venous Thromboembolism Prevention in Hip and Knee Arthroplasty Differ What Are the Implications for Clinicians and Patients?
American Association of Orthopedic Surgeons and American College of Chest Physicians Guidelines for Venous Thromboembolism Prevention in Hip and Knee Arthroplasty Differ What Are the Implications for Clinicians and Patients?
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DOI：
10.1378/chest.08-2655
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发表时间：
2009-02-01
期刊：
影响因子：
9.6
通讯作者：
Hirsh, Jack
中科院分区：
文献类型：
--
作者：
Eikelboom, John W.;Karthikeyan, Ganesan;Hirsh, Jack
最近出版的美国骨科医师协会（AAOS）关于髋关节或膝关节手术患者静脉血栓栓塞（VTE）预防的指南与长期建立和广泛使用的美国胸科医师学会（ACCP）指南相冲突。两份指南都承认，髋关节或膝关节置换术患者预防血栓的最重要目标是预防肺栓塞（PE）。ACCP指南包括通过静脉造影检测无症状（和有症状的）深静脉血栓形成（DVT）作为血栓预防效果的衡量标准，而AAOS拒绝将DV作为有效的结果，因为小组成员认为DVT和PE之间的联系尚未得到证实。AAOS的立场与影像学研究将DVT与PE联系起来的证据以及临床研究的证据不一致，这些研究表明，与安慰剂或未经治疗的对照组相比，抗血栓药物可以平行降低DVT和PE。AAOS小组忽略了证明血栓预防可以减少DVT和PE的随机数据，他们的许多建议都是基于专家意见，缺乏科学依据。我们推荐ACCP指南，因为其方法明确而严谨，治疗建议反映了随机试验的所有证据。采用ACCP指南将确保接受髋关节和膝关节置换术的患者接受预防静脉血栓栓塞的最佳治疗，并减少由于这种常见且潜在可预防的疾病而导致的残疾和死亡。（chest 2009; 135:513-520）
The recently published American Association of Orthopedic Surgeons (AAOS) guidelines For the prevention of venous thromboembolism (VTE) in patients undergoing hip or knee surgery conflict with long-established and widely used American College of Chest Physicians (ACCP) guidelines. Both guidelines accepted that the most important goal of thromboprophylaxis in patients undergoing hip or knee replacement is to prevent pulmonary, embolism (PE). The ACCP guidelines included asymptomatic (and symptomatic) deep vein thrombosis (DVT) detected by venography as a measure of the efficacy of thromboprophylaxis, whereas the AAOS rejected DV as a valid outcome because the panelists considered the link between DVT and PE to be unproven. The AAOS position is inconsistent with evidence from imaging studies linking DVT with PE and from clinical studies demonstrating a parallel reduction of DVT and PE when antithrombotic agents are compared with placebo or untreated controls. The AAOS panel ignored the randomized data demonstrating that thromboprophylaxis reduces both DVT and PE, and many of their recommendations are based on expert opinion and lack a scientific basis. We recommend the ACCP guidelines because the methodology is explicit and rigorous and the treatment recommendations reflect all of the evidence from the randomized trials. Adoption of the ACCP guideline will ensure that patients undergoing hip and knee arthroplasty receive the best available therapies for prevention of VTE and reduce disability and death due to this common and potentially preventable condition. (CHEST 2009; 135:513-520)