JAMA Clinical Guidelines Synopsis September 23, 2019
Prevention and Management of Venous Thromboembolism
Jonathan D. Paul, Adam S. Cifu
JAMA. Published online September 23, 2019. doi:10.1001/jama.2019.13853
Guideline title 指南题目
2018 Guidelines for Management of Venous Thromboembolism
2018静脉血栓栓塞治疗指南
Developers 制定者
American Society of Hematology (ASH) and McMaster University GRADE Centre
美国血液病学会(ASH)及McMaster大学GRADE中心
Release date 发布日期
November 27, 2018
2018年11月27日
Funding source 资助来源
ASH
Target population 目标人群
Hospitalized and nonhospitalized medical patients, pregnant women, and children
医院及非住院内科患者、孕妇及儿童
Major recommendations 主要推荐意见
- In all acutely ill medical patients, venous thromboembolism (VTE) prophylaxis is recommended during hospitalization but not after discharge (strong recommendation; moderate certainty).
- 对于所有急性病的内科患者，推荐在住院期间而非出院后进行静脉血栓栓塞(VTE)的预防（强推荐；中等确定性）
- For VTE prophylaxis, low-molecular-weight heparin (LMWH) or fondaparinux is preferred over unfractionated heparin (UFH) (conditional recommendation; low certainty for LMWH in non–critically ill patients; moderate certainty for LMWH in critically ill patients; very low certainty for fondaparinux) and over a direct oral anticoagulant (DOAC) (strong recommendation; moderate certainty).
- 预防VTE时，低分子肝素(LMWH)或磺达肝癸钠优于普通肝素(UFH)（有条件推荐；LMWH用于危重病患者低确定性；磺达肝癸钠极低确定性），且优于直接口服抗凝药(DOAC)（强推荐；中等确定性）。
- A strategy that begins with D-dimer for excluding pulmonary embolism (PE) in a population with low prevalence/pretest probability (≤5%) is recommended, followed by ventilation perfusion (V̇Q̇) scan or computed tomography pulmonary angiography (CTPA) for patients requiring additional testing (strong recommendation; moderate to high certainty).
- 对于罹患率/验前概率较低(≤5%)的人群，推荐策略首先测定D-二聚体排除肺栓塞(PE)，对需要进一步检查的患者随后进行通气血流 (V̇Q̇) 扫描或CTPA（强推荐；中等至高确定性）。
- For patients at low to moderate risk of recurrent VTE who require interruption of vitamin K antagonist therapy for invasive procedures, the guideline recommends against periprocedural bridging with LMWH or UFH in favor of interruption alone (strong recommendation; moderate certainty).
- 对于复发性VTE低至中度风险的患者，如果因有创操作需要中断维生素K拮抗剂治疗，指南不建议在有创操作前后过渡到LMWH或UFH，可考虑单纯中断治疗（强推荐；中等确定性）。
- For pregnant women with acute VTE, antithrombotic therapy is recommended (strong recommendation; high certainty) with LMWH over UFH (strong recommendation; moderate certainty).
- 对于罹患急性VTE的孕妇，推荐进行抗栓治疗（强推荐；高确定性），且LMWH优于UFH（强推荐；中等确定性）
