American Society of Hematology 2018 guidelines for management of venous thromboembolism: optimal management of anticoagulation therapy
American Society of Hematology 2018 guidelines for management of venous thromboembolism: optimal management of anticoagulation therapy
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DOI：
10.1182/bloodadvances.2018024893
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发表时间：
2018-11-27
期刊：
影响因子：
7.5
通讯作者：
Guyatt, Gordon
中科院分区：
文献类型：
--
作者：
Witt, Daniel M.;Nieuwlaat, Robby;Guyatt, Gordon
背景：临床医生在优化使用抗凝剂治疗静脉血栓栓塞 (VTE) 时面临许多实际问题。 目的：美国血液学会 (ASH) 的这些循证指南旨在支持患者、临床医生和其他医疗保健专业人员做出关于在 VTE 管理中使用抗凝剂的决定。这些指南假设已经选择了抗凝剂。方法：ASH 组建了一个多学科指南小组，进行平衡，以最大程度地减少利益冲突造成的潜在偏差。麦克马斯特大学 GRADE 中心支持指南的制定过程，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患者的重要性排列优先顺序。采用建议分级评估、制定和评估 (GRADE) 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 25 项建议和 2 项良好实践声明达成一致，以优化接受抗凝药物的患者的管理。结论：强烈建议包括使用患者自我管理国际标准化比值 (INR) 和家庭护理点 INR 监测来进行维生素 K 拮抗剂治疗，并反对使用围手术期低分子量肝素(LMWH) 桥接疗法。有条件的建议包括根据实际体重确定 LMWH 的治疗剂量，不使用抗 Xa 因子监测来指导 LMWH 剂量，使用专门的抗凝管理服务，以及在发生危及生命的出血后恢复抗凝治疗。
Background: Clinicians confront numerous practical issues in optimizing the use of anticoagulants to treat venous thromboembolism (VTE).Objective: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians and other health care professionals in their decisions about the use of anticoagulants in the management of VTE. These guidelines assume the choice of anticoagulant has already been made.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 patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence and make recommendations, which were subject to public comment.Results: The panel agreed on 25 recommendations and 2 good practice statements to optimize management of patients receiving anticoagulants.Conclusions: Strong recommendations included using patient self-management of international normalized ratio (INR) with home point-of-care INR monitoring for vitamin K antagonist therapy and against using periprocedural low-molecular-weight heparin (LMWH) bridging therapy. Conditional recommendations included basing treatment dosing of LMWH on actual body weight, not using anti-factor Xa monitoring to guide LMWH dosing, using specialized anticoagulation management services, and resuming anticoagulation after episodes of life-threatening bleeding.