From the Sigmund Freud Private University and Department of Anaesthesia and Intensive Care, Evangelical Hospital Vienna, Vienna, Austria (SK-L), Department of Anaesthesiology, Aarhus University Hospital, Aarhus, Denmark (CF-E), Orthopaedic Surgery, University Hospital Saint Luc, Brussels, Belgium (ET), and Department of Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania (GB).
Eur J Anaesthesiol. 2018 Feb;35(2):116-122. doi: 10.1097/EJA.0000000000000705.
: The risk for postoperative venous thromboembolism (VTE) is increased in patients aged more than 70 years and in elderly patients presenting with co-morbidities, for example cardiovascular disorders, malignancy or renal insufficiency. Therefore, risk stratification, correction of modifiable risks and sustained perioperative thromboprophylaxis are essential in this patient population. Timing and dosing of pharmacoprophylaxis may be adopted from the non-aged population. Direct oral anti-coagulants are effective and well tolerated in the elderly; statins may not replace pharmacological thromboprophylaxis. Early mobilisation and use of non-pharmacological means of thromboprophylaxis should be exploited. In elderly patients, we suggest identification of co-morbidities increasing the risk for VTE (e.g. congestive heart failure, pulmonary circulation disorder, renal failure, lymphoma, metastatic cancer, obesity, arthritis, post-menopausal oestrogen therapy) and correction if present (e.g. anaemia, coagulopathy) (Grade 2C). We suggest against bilateral knee replacement in elderly and frail patients (Grade 2C). We suggest timing and dosing of pharmacological VTE prophylaxis as in the non-aged population (Grade 2C). In elderly patients with renal failure, low-dose unfractionated heparin (UFH) may be used or weight-adjusted dosing of low molecular weight heparin (Grade 2C). In the elderly, we recommend careful prescription of postoperative VTE prophylaxis and early postoperative mobilisation (Grade 1C). We recommend multi-faceted interventions for VTE prophylaxis in elderly and frail patients, including pneumatic compression devices, low molecular weight heparin (and/or direct oral anti-coagulants after knee or hip replacement) (Grade 1C). : This article is part of the European guidelines on perioperative venous thromboembolism prophylaxis. For details concerning background, methods, and members of the ESA VTE Guidelines Task Force, please, refer to:Samama CM, Afshari A, for the ESA VTE Guidelines Task Force. European guidelines on perioperative venous thromboembolism prophylaxis. Eur J Anaesthesiol 2018; 35:73-76.A synopsis of all recommendations can be found in the following accompanying article: Afshari A, Ageno W, Ahmed A, et al., for the ESA VTE Guidelines Task Force. European Guidelines on perioperative venous thromboembolism prophylaxis. Executive summary. Eur J Anaesthesiol 2018; 35:77-83.
: 年龄超过 70 岁的患者和伴有合并症（例如心血管疾病、恶性肿瘤或肾功能不全）的老年患者发生术后静脉血栓栓塞（VTE）的风险增加。因此，在这些患者人群中，风险分层、纠正可改变的风险和持续围手术期血栓预防至关重要。药物预防的时机和剂量可采用非老年人群的方法。直接口服抗凝剂在老年人中有效且耐受良好；他汀类药物可能无法替代药物性血栓预防。应充分利用早期活动和非药物性血栓预防措施。对于老年患者，我们建议确定增加 VTE 风险的合并症（例如充血性心力衰竭、肺循环障碍、肾功能衰竭、淋巴瘤、转移性癌症、肥胖、关节炎、绝经后雌激素治疗）并在存在时进行纠正（例如贫血、凝血障碍）（2C 级）。我们建议避免在老年和体弱患者中双侧膝关节置换术（2C 级）。我们建议在非老年人群中使用药物性 VTE 预防的时机和剂量（2C 级）。对于肾功能衰竭的老年患者，可使用低剂量未分馏肝素（UFH）或根据体重调整低分子肝素的剂量（2C 级）。在老年人中，我们建议谨慎开具术后 VTE 预防药物并在术后早期活动（1C 级）。我们建议对老年和体弱患者进行多方面的 VTE 预防干预，包括气动压缩装置、低分子肝素（和/或膝关节或髋关节置换术后的直接口服抗凝剂）（1C 级）。 : 本文是围手术期静脉血栓栓塞预防欧洲指南的一部分。有关背景、方法和 ESA VTE 指南工作组的成员，请参阅：Samama CM，Afshari A，ESA VTE 指南工作组。围手术期静脉血栓栓塞预防欧洲指南。Eur J Anaesthesiol 2018；35：73-76. 所有建议的摘要可在以下相关文章中找到：Afshari A，Ageno W，Ahmed A，等，ESA VTE 指南工作组。围手术期静脉血栓栓塞预防欧洲指南。执行摘要。Eur J Anaesthesiol 2018；35：77-83.
