Inflammation and the Host Response to Injury a Large-Scale Collaborative Project: Patient-Oriented Research Core Standard Operating Procedure for Clinical Care X. Guidelines for Venous Thromboembolism Prophylaxis in the Trauma Patient
Inflammation and the Host Response to Injury a Large-Scale Collaborative Project: Patient-Oriented Research Core Standard Operating Procedure for Clinical Care X. Guidelines for Venous Thromboembolism Prophylaxis in the Trauma Patient
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DOI：
10.1097/ta.0b013e3181826df7
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发表时间：
2008-10-01
影响因子：
--
通讯作者：
Maier, Ronald V.
中科院分区：
文献类型：
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作者：
Cuschieri, Joseph;Freeman, Brad;Maier, Ronald V.
静脉血栓栓塞（VTE）在严重受伤患者中是一个常见的问题，可能导致大量的发病率、死亡率和资源消耗。（1-3）事实上，在所有住院患者亚组中，创伤恢复期患者的静脉血栓栓塞发生率最高。(4)根据患者队列和诊断方式。深静脉血栓形成（DVT）和肺栓塞（PE）的发生率可能分别高达40%和20%。（5.6）以大量PE形式发展的静脉血栓形成不仅会导致受伤患者的晚期死亡，而且在损伤后的任何时间发展静脉血栓形成也会使治疗复杂化，并可能导致严重的长期后遗症。为了降低静脉血栓栓塞的风险，许多医生使用机械或药物预防血栓，或两者兼而有之。虽然，许多干预措施已经被评估为在特定的受伤患者亚群中预防静脉血栓栓塞的潜在功效，但关于平衡静脉血栓栓塞风险和治疗并发症风险的最佳预防方法的数据仍然是不确定的。（7.8）一些基于证据的指南已被提出，其应用程度和有效性各不相同，主要是由于对出血增加的担忧。(6)然而，延迟开始预防与静脉血栓栓塞发生率增加3倍有关。(9)静脉血栓栓塞发生延迟的发生率增加很可能是继发于静脉血栓栓塞比预期更早的发展。事实上。大量患者在受伤后24小时内诊断出静脉血栓栓塞，大约三分之一的静脉血栓栓塞病例在受伤后一周内诊断出静脉血栓栓塞。（9.10）由于缺乏一致的数据，需要进行充分设计的前瞻性评估，以确定该领域的最佳实践。作为炎症和宿主对损伤的反应大规模合作研究项目的一部分，参与的研究人员根据现有的最佳证据和专家意见制定了静脉血栓栓塞预防指南，以标准化参与中心的这方面的护理。
Venous thromboembolism (VTE) in seriously injured patients is a common problem that can potentially lead to Substantial morbidity, mortality, and resource expenditure.(1-3) In fact, patients recovering from trauma have the highest rate of VTE among all subgroups of hospitalized patients.(4) Depending on the patient cohort and diagnostic modality. rates of deep venous thrombosis (DVT) and pulmonary embolism (PE) may be as high as 40% and 20%, respectively.(5.6) Not only is the development of VTE in the form of a massive PE a cause of late death in the injured patient, VTE development anytime after injury complicates management and can lead to significant long-term sequelae. To reduce the risk of VTE, many practitioners administer mechanical or pharmacologic thromboprophylaxis or both.Although, numerous interventions have been evaluated L I for potential efficacy in preventing VTE in selected subpopulations Of injured patients, the data on the optimal method of prophylaxis that balances risk of VTE with risk of complications from therapy remains inconclusive.(7.8) On the basis of the current data. several evidence-based guidelines have been proposed with varying degrees of application and effectiveness, primarily due to concerns of increased bleeding.(6) However, delay in the initiation of prophylaxis is associated with a 3-fold increase in the incidence of VTE.(9) This increased incidence in VTE occurring with delayed initiation is most likely secondary to an earlier than expected development of VTE. In fact. VTE has been diagnosed in a significant number of patients within the first 24 hours after injury and approximately one-third of all cases of VTE are diagnosed within 1 week of injury.(9.10) The lack of consistent data emphasizes the need for adequately designed prospective evaluations to define optimal practice in this area. As part of the Inflammation and the Host Response to Injury Large-Scale Collaborative Research Program, the participating investigators have developed guidelines for VTE prophylaxis based on best available evidence and expert opinion to standardize this aspect of care among participating centers.