Sunnybrook Health Sciences Centre, Department of Medicine, University of Toronto, Toronto, ON, Canada.
Hematology Am Soc Hematol Educ Program. 2009:286-92. doi: 10.1182/asheducation-2009.1.286.
The last 50 years have witnessed a multitude of publications evaluating the efficacy, safety and cost effectiveness of many different thromboprophylaxis interventions. There is widespread consensus that thromboprophylaxis safely reduces morbidity and mortality. More than 25 evidence-based guidelines, published since 1986, also recommend routine thromboprophylaxis in the majority of hospitalized patients. As a result, thromboprophylaxis is recognized as a key safety priority for hospitals. Some of the remaining areas of controversy that will be discussed in this paper include the role of individual risk assessments to determine thrombosis risk and prophylaxis, replacement of low-dose heparin by low-molecular-weight heparin (LMWH), the optimal duration of prophylaxis, the role of combined thromboprophylaxis modalities, the safety of anticoagulant prophylaxis with regional analgesia, the use of LMWHs in chronic renal insufficiency, and the emerging role of new oral anticoagulants as thromboprophylactic agents. Despite the overwhelming evidence supporting thromboprophylaxis, rates of thromboprophylaxis use remain far from optimal. Successful implementation strategies to bridge this knowledge:care gap are the most important current challenges in this area. These strategies must be multifaceted, utilizing local, systems-based approaches as well as legislation and incentives that reinforce best practices.
在过去的 50 年中，已经有大量的出版物评估了许多不同的血栓预防干预措施的疗效、安全性和成本效益。广泛的共识是，血栓预防安全地降低发病率和死亡率。自 1986 年以来发布的 25 多个循证指南也建议对大多数住院患者进行常规血栓预防。因此，血栓预防被认为是医院的一个关键安全重点。本文将讨论一些仍然存在争议的领域，包括个体风险评估在确定血栓风险和预防中的作用、用低分子肝素（LMWH）替代低剂量肝素、预防的最佳持续时间、联合血栓预防方法的作用、区域镇痛抗凝预防的安全性、在慢性肾功能不全中使用 LMWH 以及新型口服抗凝剂作为血栓预防剂的新兴作用。尽管有大量证据支持血栓预防，但血栓预防的使用率仍远未达到最佳水平。成功实施策略以弥合这一知识差距是该领域当前最重要的挑战。这些策略必须是多方面的，利用基于本地和系统的方法以及立法和激励措施来强化最佳实践。
