Lachiewicz Paul F
Department of Surgery, Section of Orthopaedic Surgery, Duke University Medical Center and Durham VA Medical Center, Durham, USA.
Orthopedics. 2009 Dec;32(12 Suppl):74-8. doi: 10.3928/01477447-20091103-52.
Orthopedists have expressed concerns regarding the utility for and applicability to their practices of guidelines from the American College of Chest Physicians (ACCP) for thromboprophylaxis in the settings of total hip and total knee arthroplasty (THA and TKA, respectively). These concerns include the acceptance by the ACCP of venographically assessed asymptomatic deep venous thrombosis as a meaningful clinical trial endpoint and a potential underestimation by the ACCP of the true risk of major bleeding and wound complication in unselected patient populations outside carefully controlled clinical trials. Because symptomatic pulmonary embolism is rare after THA and TKA, the American Academy of Orthopaedic Surgeons has developed a clinical practice guideline focused on preventing this complication while minimizing the risk of bleeding due to pharmacologic prophylaxis. These guidelines are reviewed here.
骨科医生对美国胸科医师学会（ACCP）关于全髋关节置换术和全膝关节置换术（分别为THA和TKA）中血栓预防的指南在其实践中的实用性和适用性表示担忧。这些担忧包括ACCP将静脉造影评估的无症状深静脉血栓形成作为有意义的临床试验终点，以及ACCP可能低估了在精心控制的临床试验之外的未选择患者群体中发生大出血和伤口并发症的真实风险。由于THA和TKA后症状性肺栓塞很少见，美国骨科医师学会制定了一项临床实践指南，重点是预防这种并发症，同时将药物预防导致出血的风险降至最低。本文对这些指南进行了综述。
