Kroeger Knut, Kujath Peter
Angiologie, HELIOS Kliniken Krefeld, Deutschland.
Klinik für Viszeral-, Gefäß- und Thoraxchirurgie, Westküstenklinikum Heide, Deutschland.
Zentralbl Chir. 2017 Oct;142(5):492-495. doi: 10.1055/s-0043-119893. Epub 2017 Oct 27.
In this age of evidence-based medicine, the use of medical thrombosis prophylaxis stockings (AES) as a physical strategy for the prevention of lower limb venous thrombosis has been questioned. The current German S3 guidelines even state that their non-application is, in the vast majority of cases, explicitly covered by the recommendations of this guideline. Low molecular weight heparins (NMH) and direct oral anticoagulants (DOAK) have received approval for thrombosis prophylaxis in elective knee and hip joint replacement, but the use of AES is absent from these approval studies. The results of the additional effects of the AES in the approval studies of Edoxaban were published for the first time. According to these results, the incidence of venous thromboembolism was 6.0% when AES were worn and 13.0% when AES were not worn. Since the approval studies of NMH and the DOAKs did not control for the use of AES, the impact of AES on the overall results remains unclear. Therefore the study results are only valid in the context of the general application of AES. Guidelines commissions should take this into account in their recommendations.
在这个循证医学时代，医用血栓预防袜（AES）作为预防下肢静脉血栓形成的一种物理策略受到了质疑。当前德国S3指南甚至指出，在绝大多数情况下，本指南的建议明确涵盖了不使用AES的情况。低分子量肝素（NMH）和直接口服抗凝剂（DOAK）已获批用于择期膝关节和髋关节置换手术中的血栓预防，但这些获批研究中未涉及AES的使用。艾多沙班获批研究中AES附加效应的结果首次发表。根据这些结果，佩戴AES时静脉血栓栓塞的发生率为6.0%，未佩戴AES时为13.0%。由于NMH和DOAK的获批研究未对AES的使用进行控制，AES对总体结果的影响仍不明确。因此，研究结果仅在AES普遍应用的背景下有效。指南委员会在其建议中应考虑到这一点。
