Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark.
The Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement, Copenhagen, Denmark.
J Thromb Haemost. 2019 Feb;17(2):250-253. doi: 10.1111/jth.14362. Epub 2019 Jan 11.
Venous thromboembolic events remain a concern in total hip and knee arthroplasty. Consequently, several guidelines on thromboprophylaxis have been established. However, despite similarities in methodology for evaluation of evidence, discrepancies in guideline recommendations continue to exist. Furthermore, the results of older randomized clinical trials still have significant influence despite major improvements in perioperative care. In contrast, the results of recent large cohort studies with fewer thromboembolic events are mostly used only for background data. Here we outline some of the differences between the guidelines on thromboprophylaxis from the American College of Chest Physicians, the National Institute for Health and Care Excellence and the American Academy of Orthopedic Surgeons. We discuss differences in the methodology and focus of the guidelines potentially influencing the final recommendations. Future analyses are required, including data from modern care with early mobilization and short length of stay.
静脉血栓栓塞事件仍然是全髋关节和膝关节置换术的关注点。因此，已经制定了几项关于血栓预防的指南。然而，尽管评估证据的方法相似，但指南建议仍然存在差异。此外，尽管围手术期护理有了重大改进，但旧的随机临床试验结果仍然具有重要影响。相比之下，最近的大型队列研究结果由于血栓栓塞事件较少，主要只用于背景数据。在这里，我们概述了美国胸科医师学院、英国国家卫生与临床优化研究所和美国矫形外科医师学会的血栓预防指南之间的一些差异。我们讨论了可能影响最终建议的指南方法和重点的差异。需要进行未来的分析，包括采用早期活动和缩短住院时间的现代护理数据。
