Kierner Katharina A, Gartner Verena, Schwarz Maria, Watzke Herbert H
Unit of Palliative Care, Department of Medicine I, Medical University of Vienna, Austria.
Am J Hosp Palliat Care. 2008 Apr-May;25(2):127-31. doi: 10.1177/1049909107310142. Epub 2008 Jan 15.
Study-based guidelines on thromboprophylaxis are not available for palliative care patients. The authors asked a panel of academic medical experts in palliative care, oncology, blood coagulation, and intensive care to select a prophylactic regimen out of 5 predefined options for a virtual patient with advanced bronchial cancer in different clinical settings. Primary prophylaxis for venous thromboembolism was withdrawn by all physicians when the patient had a Karnovsky's index of 10 and was described as dying. It was given by 25% of physicians when the patient had a Karnovsky's index of 20 and by 85% when Karnovsky's index 40 was still 40. Similar results were obtained in the situation of secondary prophylaxis of venous thromboembolism and when the patient was described as having a history of chronic atrial fibrillation. This data clearly show that thromboprophylaxis is delivered according to a compound estimate of risks and benefits of such prophylaxis in a specific palliative care situation.
针对姑息治疗患者，尚无基于研究的血栓预防指南。作者邀请了一组姑息治疗、肿瘤学、血液凝固和重症监护领域的学术医学专家，从5种预定义方案中为一名处于不同临床情况的晚期支气管癌虚拟患者选择一种预防方案。当患者卡诺夫斯基指数为10且被描述为濒死时，所有医生都停止了对静脉血栓栓塞的一级预防。当患者卡诺夫斯基指数为20时，25%的医生进行了预防；当卡诺夫斯基指数仍为40时，85%的医生进行了预防。在静脉血栓栓塞的二级预防情况以及患者被描述为有慢性房颤病史时，也获得了类似结果。这些数据清楚地表明，在特定的姑息治疗情况下，血栓预防是根据这种预防措施的风险和益处的综合评估来实施的。
