Shargall Yaron, Brunelli Alessandro, Murthy Sudish, Schneider Laura, Minervini Fabrizio, Bertolaccini Luca, Agzarian John, Linkins Lori-Ann, Kestenholz Peter, Li Hui, Rocco Gaetano, Girard Philippe, Venuta Federico, Samama Marc, Scarci Marco, Anraku Masaki, Falcoz Pierre-Emmanuel, Kirk Alan, Solli Piergiorgio, Hofstetter Wayne, Okumura Meinoshin, Douketis James, Litle Virginia
Department of Surgery, McMaster University, Hamilton, ON, Canada.
Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK.
Eur J Cardiothorac Surg. 2020 Feb 1;57(2):331-337. doi: 10.1093/ejcts/ezz191.
Venous thromboembolic events (VTE) after thoracic surgery (TS) can be prevented with mechanical and chemical prophylaxis. Unlike other surgical specialties, TS lacks evidence-based guidelines. In the process of developing these guidelines, an understanding of the current prophylaxis methods practiced internationally is necessary and is described in this article.
A 26-item survey was distributed to members of the European Society of Thoracic Surgeons (ESTS), American Association of Thoracic Surgery (AATS), Japanese Association for Chest Surgery (JACS) and Chinese Society for Thoracic and Cardiovascular Surgery (CSTCS) electronically or in person. Participants were asked to report their current prophylaxis selection, timing of initiation and duration of prophylaxis, perceived risk factors and the presence and adherence to institutional VTE guidelines for patients undergoing TS for malignancies.
In total, 1613 surgeons anonymously completed the survey with an overall 36% response rate. Respondents were senior surgeons working in large academic hospitals (≥70%, respectively). More than 83.5% of ESTS, AATS and JACS respondents report formal TS thromboprophylaxis protocols in their institutions, but 53% of CSTCS members report not having such a protocol. The regions varied in the approaches utilized for VTE prophylaxis, the timing of initiation perioperatively and the use and type of extended prophylaxis. Respondents reported that multiple risk factors and sources of information impact their VTE prophylaxis decision-making processes, and these factors vastly diverge regionally.
There is little agreement internationally on the optimal approach to thromboprophylaxis in the TS population, and guidelines will be helpful and vastly welcomed.
胸外科手术（TS）后的静脉血栓栓塞事件（VTE）可通过机械和药物预防措施来预防。与其他外科专科不同，胸外科手术缺乏循证指南。在制定这些指南的过程中，有必要了解国际上目前实施的预防方法，本文对此进行了描述。
向欧洲胸外科医师协会（ESTS）、美国胸外科协会（AATS）、日本胸外科协会（JACS）和中国胸心血管外科医师协会（CSTCS）的成员以电子方式或亲自发放了一份包含26个条目的调查问卷。参与者被要求报告他们目前的预防措施选择、开始时间和预防持续时间、感知到的风险因素以及针对接受恶性肿瘤胸外科手术患者的机构VTE指南的存在情况和遵循情况。
共有1613名外科医生匿名完成了调查，总体回复率为36%。受访者均为在大型学术医院工作的资深外科医生（分别≥70%）。超过83.5%的ESTS、AATS和JACS受访者报告其所在机构有正式的胸外科手术血栓预防方案，但53%的CSTCS成员报告没有这样的方案。不同地区在VTE预防所采用的方法、围手术期开始时间以及延长预防的使用和类型方面存在差异。受访者报告称，多种风险因素和信息来源影响他们的VTE预防决策过程，而且这些因素在地区上差异很大。
国际上对于胸外科手术人群血栓预防的最佳方法几乎没有共识，指南将很有帮助且会受到广泛欢迎。
