是否存在一个最佳的策略,以预防VTE在重症患者:从指导方针和随机对照试验的见解
Di Wei1, Sinan Ma2, Weijia Huang2
1Department of Pharmacy, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China; Department of Pharmacy, The Xi'an GaoXin Hospital, Xi'an 710075, China.
European journal of internal medicine
|July 26, 2025
概括
在重症患者中预防静脉血栓塞栓症 (VTE) 缺乏共识. 这项研究发现,各种抗凝血剂在VTE预防有效性上没有显著差异,突出了临床实践指南中的质量差距.
科学领域:
- 临界护理医学 临界护理医学
- 药理学 药理学是指药理学的学科.
- 基于证据的医学 基于证据的医学
背景情况:
- 危急病患者在静脉血栓栓塞 (VTE) 预防方面存在独特的挑战.
- 现有的临床实践指南 (CPG) 和抗凝剂疗效缺乏共识.
- 这项研究系统地评估VTE预防的CG质量和抗凝血疗法.
研究的目的:
- 评估CPGs的质量和临床适用性,以预防危急病患者的VTE.
- 为了比较不同抗凝血剂在静脉瘤预防中的疗效和安全性.
- 为VTE预防策略提供基于证据的建议.
主要方法:
- 17项CPG和12项随机对照试验 (7636名患者) 的系统审查和网络元分析.
- 使用AGREE II和RIGHT工具评估CPG质量.
- 低分子量肝素 (LMWHs) 和未分离肝素 (UFH) 的网络比较用于血栓预防.
主要成果:
- 在利益相关者参与和适用性 (AGREE II) 和报告不足 (RIGHT) 方面,CPG的得分很低.
- 四个CPG已经证明了其高临床适用性:NICE2019,ACCP2012,ASH2018,ASH2019.
- 在LMWH之间或LMWH和UFH之间,VTE,DVT或PE减少没有显著差异.
- 聚合的LMWH显示DVT与UFH的显著减少 (OR 0.71,95%CRI:0.42-0.99).
结论:
- 目前的VTE预防CPG的质量和适用性存在显著的变化.
- 目前的临床证据不支持在重症患者中任何特定的VTE预防策略的卓越预防疗效.
- 需要进一步的研究来完善VTE预防指南和在重症监护机构的抗凝剂使用.
相关概念视频
Venous Thrombosis III: Interprofessional Care
22
Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
22
Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
44
Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
44
Venous Thrombosis IV: Nursing Management
24
Nursing management begins with a thorough assessment of the patient's health history. Key factors include trauma to veins, peripherally inserted central catheters, varicose veins, recent pregnancy or childbirth, surgery, bacteremia, prolonged bed rest, atrial fibrillation, COPD, heart failure, cancer, coagulation disorders, myocardial infarction, spinal cord injury, stroke, prolonged travel, recent bone fractures, and dehydration. Review medication intake, particularly oral contraceptives,...
24
Pulmonary Embolism III: Nursing Management
42
A pulmonary embolism occurs when a thrombus, amniotic fluid, tumor tissue, fat, or air embolus blocks one or more pulmonary arteries. Effective nursing management and patient education are crucial for improving outcomes and preventing recurrence.Nursing management starts with obtaining a comprehensive patient history, particularly noting any history of deep vein thrombosis (DVT). Assess for clinical manifestations, including dyspnea, chest pain, crackles, heart murmurs, and signs of right-sided...
42
Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies
37
The key difference between Superficial Vein Thrombosis (SVT) and Deep Vein Thrombosis (DVT) lies in their location and severity.Clinical ManifestationsSVT typically presents with localized pain, tenderness, and redness along the course of a superficial vein, often accompanied by a palpable, cord-like structure under the skin. This condition is usually less dangerous than DVT but can be uncomfortable and may lead to complications such as cellulitis or, rarely, a clot extension into the deep...
37
Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
1.3K
Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
1.3K


