Khatri Amulya, Machin Matthew, Vijay Aditya, Salim Safa, Shalhoub Joseph, Davies Alun Huw
Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, London W6 8RF, UK.
Imperial Vascular Unit, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK.
J Clin Med. 2021 Sep 22;10(19):4294. doi: 10.3390/jcm10194294.
Venous thromboembolism (VTE) remains an important consideration within surgery, with recent evidence looking to refine clinical guidance. This review provides a contemporary update of existing clinical evidence for antithrombotic regimens for surgical patients, providing future directions for prophylaxis regimens and research. For moderate to high VTE risk patients, existing evidence supports the use of heparins for prophylaxis. Direct oral anticoagulants (DOACs) have been validated within orthopaedic surgery, although there remain few completed randomised controlled trials in other surgical specialties. Recent trials have also cast doubt on the efficacy of mechanical prophylaxis, especially when adjuvant to pharmacological prophylaxis. Despite the ongoing uncertainty in higher VTE risk patients, there remains a lack of evidence for mechanical prophylaxis in low VTE risk patients, with a recent systematic search failing to identify high-quality evidence. Future research on rigorously developed and validated risk assessment models will allow the better stratification of patients for clinical and academic use. Mechanical prophylaxis' role in modern practice remains uncertain, requiring high-quality trials to investigate select populations in which it may hold benefit and to explore whether intermittent pneumatic compression is more effective. The validation of DOACs and aspirin in wider specialties may permit pharmacological thromboprophylactic regimens that are easier to administer.
静脉血栓栓塞症（VTE）仍是手术中需要重点关注的问题，近期有证据表明需完善临床指南。本综述对手术患者抗血栓治疗方案的现有临床证据进行了当代更新，为预防方案和研究提供了未来方向。对于中度至高度VTE风险患者，现有证据支持使用肝素进行预防。直接口服抗凝剂（DOACs）已在骨科手术中得到验证，尽管在其他外科专科完成的随机对照试验仍然很少。近期试验也对机械预防的效果提出了质疑，尤其是在作为药物预防辅助手段时。尽管高VTE风险患者的情况仍不确定，但低VTE风险患者缺乏机械预防的证据，最近的系统检索未能找到高质量证据。未来对严格开发和验证的风险评估模型的研究将有助于更好地对患者进行分层，以用于临床和学术目的。机械预防在现代实践中的作用仍不确定，需要高质量试验来研究可能从中受益的特定人群，并探讨间歇性气动压迫是否更有效。DOACs和阿司匹林在更广泛专科中的验证可能会产生更易于给药的药物性血栓预防方案。
