Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, China.
Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, China.
Thromb Res. 2018 Jun;166:10-18. doi: 10.1016/j.thromres.2018.03.017. Epub 2018 Mar 27.
Despite the availability of clinical practice guidelines (CPGs), the risk of death or thromboembolic complication associated with heparin-induced thrombocytopenia (HIT) remains high. Our aim was to systematically review the quality of CPGs for HIT and summarize the recommendations.
CPGs for HIT were systematically searched on PubMed, Embase, guidelines' websites, and Google up to August 6, 2017. Independently, three appraisers assessed the quality of CPGs using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument and extracted the data. Recommendations were summarized, and a comparative study was conducted to analyze the consistency among guidelines.
A total of 11 CPGs were evaluated. The quality assessed by AGREE II varied widely, not only between domains within guidelines, but also between guidelines across domains. The domain of scope and purpose and clarity of presentation obtained the highest median scores, while the domain of rigor of development and editorial independence obtained the lowest median scores. The ACCP guideline and BSH guideline were recommended for use in dealing with HIT, achieving a score of at least 50% in all six AGREE II domains. Recommendations across guidelines were inconsistent, especially in the choice of non-heparin anticoagulant for HIT.
Future HIT guidelines should place more emphasis on methodological quality and improve efforts to include cost and local availability of drugs when providing recommendations.
尽管有临床实践指南（CPGs），肝素诱导的血小板减少症（HIT）相关的死亡或血栓栓塞并发症的风险仍然很高。我们的目的是系统地审查 HIT 的 CPG 质量，并总结建议。
我们在 PubMed、Embase、指南网站和 Google 上系统地搜索了 HIT 的 CPG，截至 2017 年 8 月 6 日。三位评估员使用评估指南研究与评估 II （AGREE II）工具独立评估 CPG 的质量，并提取数据。总结了建议，并进行了比较研究，以分析指南之间的一致性。
共评估了 11 项 CPG。AGREE II 评估的质量差异很大，不仅在指南内的各个领域之间存在差异，而且在不同领域的指南之间也存在差异。范围和目的以及表述清晰度这两个领域的得分最高，而开发的严谨性和编辑独立性这两个领域的得分最低。ACCP 指南和 BSH 指南被推荐用于处理 HIT，在 AGREE II 的所有六个领域都至少获得 50%的分数。指南之间的建议不一致，特别是在选择非肝素抗凝剂治疗 HIT 方面。
未来的 HIT 指南应更加重视方法学质量，并在提供建议时努力纳入药物的成本和当地可用性。
