Duke Clinical Research Institute, Duke University Medical Center, Box 3850, Durham, NC 27710, USA.
J Thromb Thrombolysis. 2011 Jan;31(1):122-32. doi: 10.1007/s11239-010-0522-0.
Venous thromboembolism is a major cause of morbidity and mortality worldwide and most often affects hospitalized postoperative surgical and medical patients. Venous thromboembolism prophylaxis undoubtedly improves the care of these patients, as demonstrated by the current literature and guidelines. Failure to prescribe prophylaxis when indicated, however, remains a vital health care concern. The American College of Chest Physicians (ACCP) published their most recent guidelines regarding venous thromboembolism prophylaxis in 2008. In this review, we aim to summarize the most recent ACCP prophylaxis guidelines with practical application and interpretation for the practicing physician. Here we present the most practical information from these guidelines and summarize essential recommendations in key tables. We will briefly review the grading system used in the guidelines for the level of evidence and the strength of the recommendation. We will then discuss the recommendations for prophylaxis in the various patient populations described in these guidelines including general and orthopedic surgery, gynecologic surgery, urologic surgery, thoracic surgery, neurosurgery, trauma, medical conditions, cancer patients, and critical care. In addition, we will discuss recent clinical trials regarding novel anticoagulants for venous thromboembolism prophylaxis and share some conclusions.
静脉血栓栓塞症是全世界发病率和死亡率的主要原因，并且通常影响住院后的外科手术和内科患者。静脉血栓栓塞症预防无疑可以改善这些患者的护理，这已被当前的文献和指南所证明。然而，在需要时未能开具预防药物仍然是一个重要的医疗保健问题。美国胸科医师学院（ACCP）于 2008 年发布了其关于静脉血栓栓塞症预防的最新指南。在本次综述中，我们旨在总结最新的 ACCP 预防指南，并为执业医师提供实用的应用和解释。在这里，我们从这些指南中呈现最实用的信息，并在关键表格中总结基本建议。我们将简要回顾指南中用于证据水平和推荐强度的分级系统。然后，我们将讨论这些指南中描述的各种患者人群的预防建议，包括普通外科和骨科手术、妇科手术、泌尿科手术、胸外科、神经外科、创伤、内科疾病、癌症患者和重症监护。此外，我们将讨论关于新型抗凝剂用于静脉血栓栓塞症预防的最新临床试验，并分享一些结论。
