Department of Medicine, McGill University, Montreal, QC, Canada.
Department of Medicine, McMaster University, Hamilton, ON, Canada.
Chest. 2012 Feb;141(2 Suppl):e195S-e226S. doi: 10.1378/chest.11-2296.
This guideline addressed VTE prevention in hospitalized medical patients, outpatients with cancer, the chronically immobilized, long-distance travelers, and those with asymptomatic thrombophilia.
This guideline follows methods described in Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines in this supplement.
For acutely ill hospitalized medical patients at increased risk of thrombosis, we recommend anticoagulant thromboprophylaxis with low-molecular-weight heparin (LMWH), low-dose unfractionated heparin (LDUH) bid, LDUH tid, or fondaparinux (Grade 1B) and suggest against extending the duration of thromboprophylaxis beyond the period of patient immobilization or acute hospital stay (Grade 2B). For acutely ill hospitalized medical patients at low risk of thrombosis, we recommend against the use of pharmacologic prophylaxis or mechanical prophylaxis (Grade 1B). For acutely ill hospitalized medical patients at increased risk of thrombosis who are bleeding or are at high risk for major bleeding, we suggest mechanical thromboprophylaxis with graduated compression stockings (GCS) (Grade 2C) or intermittent pneumatic compression (IPC) (Grade 2C). For critically ill patients, we suggest using LMWH or LDUH thromboprophylaxis (Grade 2C). For critically ill patients who are bleeding or are at high risk for major bleeding, we suggest mechanical thromboprophylaxis with GCS and/or IPC at least until the bleeding risk decreases (Grade 2C). In outpatients with cancer who have no additional risk factors for VTE we suggest against routine prophylaxis with LMWH or LDUH (Grade 2B) and recommend against the prophylactic use of vitamin K antagonists (Grade 1B).
Decisions regarding prophylaxis in nonsurgical patients should be made after consideration of risk factors for both thrombosis and bleeding, clinical context, and patients' values and preferences.
本指南针对住院内科患者、癌症门诊患者、长期卧床或久坐不动的患者、长途旅行者以及无症状血栓形成倾向患者的静脉血栓栓塞症（VTE）预防问题。
本指南遵循《抗栓治疗与血栓预防：美国胸科医师学会抗栓治疗与血栓预防临床实践指南》第 9 版中方法学描述[1]。
对于存在血栓形成风险增加的急性住院内科患者，我们建议使用低分子肝素（LMWH）、低剂量未分级肝素（LDUH）bid、LDUH tid 或磺达肝癸钠进行抗凝性血栓预防（1B 级），并建议不要将血栓预防的持续时间延长至患者固定不动或急性住院期间之外（2B 级）。对于血栓形成风险较低的急性住院内科患者，我们建议不使用药物或机械预防（1B 级）。对于存在血栓形成风险增加且有出血或高出血风险的急性住院内科患者，我们建议使用分级加压弹力袜（GCS）或间歇性气动压缩装置（IPC）进行机械性血栓预防（2C 级）。对于危重症患者，我们建议使用 LMWH 或 LDUH 进行血栓预防（2C 级）。对于有出血或高出血风险的危重症患者，我们建议使用 GCS 和/或 IPC 进行机械性血栓预防，至少在出血风险降低之前使用（2C 级）。对于无 VTE 额外危险因素的癌症门诊患者，我们建议不常规使用 LMWH 或 LDUH 进行预防（2B 级），并建议不预防性使用维生素 K 拮抗剂（1B 级）。
在考虑血栓形成和出血的风险因素、临床背景以及患者的价值观和偏好后，应决定非手术患者的预防策略。
