{"id":17766,"date":"2019-11-17T05:47:26","date_gmt":"2019-11-16T21:47:26","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=17766"},"modified":"2019-12-12T07:11:22","modified_gmt":"2019-12-11T23:11:22","slug":"jama%e4%b8%b4%e5%ba%8a%e6%8c%87%e5%8d%97%e6%a6%82%e8%a6%81%ef%bc%9a%e9%9d%99%e8%84%89%e8%a1%80%e6%a0%93%e6%a0%93%e5%a1%9e%e7%9a%84%e9%a2%84%e9%98%b2%e4%b8%8e%e6%b2%bb%e7%96%97","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=17766","title":{"rendered":"[JAMA\u4e34\u5e8a\u6307\u5357\u6982\u8981]\uff1a\u9759\u8109\u8840\u6813\u6813\u585e\u7684\u9884\u9632\u4e0e\u6cbb\u7597"},"content":{"rendered":"\n

JAMA Clinical Guidelines Synopsis September 23, 2019<\/p>\n\n\n\n

Prevention and Management of Venous Thromboembolism<\/h1>\n\n\n\n

Jonathan D.\u00a0Paul,\u00a0Adam S.\u00a0Cifu<\/h3>\n\n\n\n

JAMA.<\/em> Published online September 23, 2019. doi:10.1001\/jama.2019.13853<\/h3>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n

Guideline title<\/strong> \u6307\u5357\u9898\u76ee<\/h3>\n\n\n\n

2018 Guidelines for Management of Venous Thromboembolism<\/p>\n\n\n\n

2018\u9759\u8109\u8840\u6813\u6813\u585e\u6cbb\u7597\u6307\u5357<\/p>\n\n\n\n

Developers<\/strong> \u5236\u5b9a\u8005<\/h3>\n\n\n\n

American Society of Hematology (ASH) and McMaster University GRADE Centre<\/p>\n\n\n\n

\u7f8e\u56fd\u8840\u6db2\u75c5\u5b66\u4f1a(ASH)\u53caMcMaster\u5927\u5b66GRADE\u4e2d\u5fc3<\/p>\n\n\n\n

Release date<\/strong> \u53d1\u5e03\u65e5\u671f<\/h3>\n\n\n\n

November 27, 2018<\/p>\n\n\n\n

2018\u5e7411\u670827\u65e5<\/p>\n\n\n\n

Funding source<\/strong> \u8d44\u52a9\u6765\u6e90<\/h3>\n\n\n\n

ASH<\/p>\n\n\n\n

Target population<\/strong>\u00a0\u76ee\u6807\u4eba\u7fa4<\/h3>\n\n\n\n

Hospitalized and nonhospitalized medical patients, pregnant women, and children<\/p>\n\n\n\n

\u533b\u9662\u53ca\u975e\u4f4f\u9662\u5185\u79d1\u60a3\u8005\u3001\u5b55\u5987\u53ca\u513f\u7ae5<\/p>\n\n\n\n

Major recommendations<\/strong> \u4e3b\u8981\u63a8\u8350\u610f\u89c1<\/h3>\n\n\n\n
  • In all acutely ill medical patients, venous thromboembolism (VTE) prophylaxis is recommended during hospitalization but not after discharge (strong recommendation; moderate certainty).<\/li>
  • \u5bf9\u4e8e\u6240\u6709\u6025\u6027\u75c5\u7684\u5185\u79d1\u60a3\u8005\uff0c\u63a8\u8350\u5728\u4f4f\u9662\u671f\u95f4\u800c\u975e\u51fa\u9662\u540e\u8fdb\u884c\u9759\u8109\u8840\u6813\u6813\u585e(VTE)\u7684\u9884\u9632\uff08\u5f3a\u63a8\u8350\uff1b\u4e2d\u7b49\u786e\u5b9a\u6027\uff09<\/li>
  • For VTE prophylaxis, low-molecular-weight heparin (LMWH) or fondaparinux is preferred over unfractionated heparin (UFH) (conditional recommendation; low certainty for LMWH in non\u2013critically 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).<\/li>
  • \u9884\u9632VTE\u65f6\uff0c\u4f4e\u5206\u5b50\u809d\u7d20(LMWH)\u6216\u78fa\u8fbe\u809d\u7678\u94a0\u4f18\u4e8e\u666e\u901a\u809d\u7d20(UFH)\uff08\u6709\u6761\u4ef6\u63a8\u8350\uff1bLMWH\u7528\u4e8e\u5371\u91cd\u75c5\u60a3\u8005\u4f4e\u786e\u5b9a\u6027\uff1b\u78fa\u8fbe\u809d\u7678\u94a0\u6781\u4f4e\u786e\u5b9a\u6027\uff09\uff0c\u4e14\u4f18\u4e8e\u76f4\u63a5\u53e3\u670d\u6297\u51dd\u836f(DOAC)\uff08\u5f3a\u63a8\u8350\uff1b\u4e2d\u7b49\u786e\u5b9a\u6027\uff09\u3002<\/li>
  • A strategy that begins with D-dimer for excluding pulmonary embolism (PE) in a population with low prevalence\/pretest probability (\u22645%) is recommended, followed by ventilation perfusion (V\u0307Q\u0307) scan or computed tomography pulmonary angiography (CTPA) for patients requiring additional testing (strong recommendation; moderate to high certainty).<\/li>
  • \u5bf9\u4e8e\u7f79\u60a3\u7387\/\u9a8c\u524d\u6982\u7387\u8f83\u4f4e(\u22645%)\u7684\u4eba\u7fa4\uff0c\u63a8\u8350\u7b56\u7565\u9996\u5148\u6d4b\u5b9aD-\u4e8c\u805a\u4f53\u6392\u9664\u80ba\u6813\u585e(PE)\uff0c\u5bf9\u9700\u8981\u8fdb\u4e00\u6b65\u68c0\u67e5\u7684\u60a3\u8005\u968f\u540e\u8fdb\u884c\u901a\u6c14\u8840\u6d41 (V\u0307Q\u0307) \u626b\u63cf\u6216CTPA\uff08\u5f3a\u63a8\u8350\uff1b\u4e2d\u7b49\u81f3\u9ad8\u786e\u5b9a\u6027\uff09\u3002<\/li>
  • 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).<\/li>
  • \u5bf9\u4e8e\u590d\u53d1\u6027VTE\u4f4e\u81f3\u4e2d\u5ea6\u98ce\u9669\u7684\u60a3\u8005\uff0c\u5982\u679c\u56e0\u6709\u521b\u64cd\u4f5c\u9700\u8981\u4e2d\u65ad\u7ef4\u751f\u7d20K\u62ee\u6297\u5242\u6cbb\u7597\uff0c\u6307\u5357\u4e0d\u5efa\u8bae\u5728\u6709\u521b\u64cd\u4f5c\u524d\u540e\u8fc7\u6e21\u5230LMWH\u6216UFH\uff0c\u53ef\u8003\u8651\u5355\u7eaf\u4e2d\u65ad\u6cbb\u7597\uff08\u5f3a\u63a8\u8350\uff1b\u4e2d\u7b49\u786e\u5b9a\u6027\uff09\u3002<\/li>
  • For pregnant women with acute VTE, antithrombotic therapy is recommended (strong recommendation; high certainty) with LMWH over UFH (strong recommendation; moderate certainty).<\/li>
  • \u5bf9\u4e8e\u7f79\u60a3\u6025\u6027VTE\u7684\u5b55\u5987\uff0c\u63a8\u8350\u8fdb\u884c\u6297\u6813\u6cbb\u7597\uff08\u5f3a\u63a8\u8350\uff1b\u9ad8\u786e\u5b9a\u6027\uff09\uff0c\u4e14LMWH\u4f18\u4e8eUFH\uff08\u5f3a\u63a8\u8350\uff1b\u4e2d\u7b49\u786e\u5b9a\u6027\uff09<\/li><\/ul>\n","protected":false},"excerpt":{"rendered":"

    JAMA Clinical Guidelines Synopsis September 2 […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[25,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17766"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=17766"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17766\/revisions"}],"predecessor-version":[{"id":17767,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17766\/revisions\/17767"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=17766"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=17766"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=17766"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}