胸外科静脉血栓栓塞症（VTE）预防的实践模式：一项全面的加拿大德尔菲调查。
Practice patterns in venous thromboembolism (VTE) prophylaxis in thoracic surgery: a comprehensive Canadian Delphi survey.
作者信息
Agzarian John, Linkins Lori-Ann, Schneider Laura, Hanna Waël C, Finley Christian J, Schieman Colin, De Perrot Marc, Crowther Mark, Douketis James, Shargall Yaron
机构信息
Department of Surgery, Faculty of Health Sciences, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada.
Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4K1, Canada.
出版信息
J Thorac Dis. 2017 Jan;9(1):80-87. doi: 10.21037/jtd.2017.01.38.
BACKGROUND
The incidence of venous thromboembolic events (VTE) after resection of thoracic malignancies can reach 15%, but prophylaxis guidelines are yet to be established. We aimed to survey Canadian practitioners regarding perioperative risk factors for VTE, impact of those factors on extended prophylaxis selection, type of preferred prophylaxis, and timing of initiation and duration of thromboprophylaxis.
METHODS
A modified Delphi survey was undertaken over three rounds with thoracic surgeons, thoracic anesthesiologists and thrombosis experts across Canada. Participants were asked to rate each parameter on a ten-point scale. Agreement was determined a priori as an item reaching a coefficient of variation of ≤30% (0.3), with the item then discontinued from later rounds.
RESULTS
In total, 72, 57 and 50 respondents participated in three consecutive rounds, respectively. Consensus was reached on previous VTE, age, cancer diagnosis, thrombophilia, poor mobilization, extended resections, and pre-operative chemotherapy as risk factors. Consensus on risk factors impacting extended prophylaxis decisions was achieved on cancer diagnosis, obesity, previous VTE and poor mobilization. With respect to perioperative prophylaxis, once daily low-molecular-weight heparin (LMWH) was the only parameter that demonstrated agreement as a common practice pattern. No agreement was achieved regarding the role of mechanical prophylaxis, unfractionated heparin (UFH) or timing of initiation of peri-operative treatment. VTE prophylaxis until discharge reached agreement but there was substantial variability regarding the role of extended prophylaxis.
CONCLUSIONS
There is agreement between Canadian clinicians treating patients with thoracic malignancies regarding most risk factors for VTE, but there is no agreement on timing of initiation of prophylaxis, the agents used or factors mandating usage of extended prophylaxis.
背景
胸段恶性肿瘤切除术后静脉血栓栓塞事件（VTE）的发生率可达15%，但预防指南尚未确立。我们旨在就VTE的围手术期危险因素、这些因素对延长预防措施选择的影响、首选预防措施的类型以及血栓预防的起始时间和持续时间，对加拿大的从业者进行调查。
方法
对加拿大各地的胸外科医生、胸段麻醉医生和血栓形成专家进行了三轮改良德尔菲调查。要求参与者以十分制对每个参数进行评分。事先确定一致性的标准为某一项目的变异系数≤30%（0.3），该项目随后不再纳入后续轮次。
结果
总共分别有72、57和50名受访者参与了连续三轮调查。就既往VTE、年龄、癌症诊断、血栓形成倾向、活动能力差、扩大切除术和术前化疗等危险因素达成了共识。在影响延长预防决策的危险因素方面，就癌症诊断、肥胖、既往VTE和活动能力差达成了共识。关于围手术期预防，每日一次的低分子肝素（LMWH）是唯一显示出作为常见做法模式达成一致的参数。在机械预防、普通肝素（UFH）的作用或围手术期治疗的起始时间方面未达成一致。直到出院的VTE预防达成了一致，但在延长预防的作用方面存在很大差异。
结论
治疗胸段恶性肿瘤患者的加拿大临床医生在VTE的大多数危险因素方面达成了一致，但在预防的起始时间、所用药物或要求使用延长预防的因素方面未达成一致。
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