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择期全髋关节置换术后预防静脉血栓栓塞——现行指南是否恰当?择期全髋关节置换术中的静脉血栓栓塞预防。

Preventing Venous Thromboembolism after elective total hip arthroplasty surgery - are the current guidelines appropriate? Venous thromboembolism prophylaxis in elective total hip arthroplasty surgery.

作者信息

Khatkar Harman, Elahi Zain, See Abbas, McDonald Stephen, Neal-Smith Greg

机构信息

Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK.

Stoke Mandeville Hospital NHS Trust, Mandeville Road, Ayelsbury, HP21 8AL, UK.

出版信息

J Clin Orthop Trauma. 2022 Jan 25;26:101782. doi: 10.1016/j.jcot.2022.101782. eCollection 2022 Mar.

Abstract

INTRODUCTION

Venous Thromboembolism after elective Total Hip Arthroplasty surgery is a well-recognised complication, resulting in fatal pulmonary embolism, post thrombotic syndrome and recurrent thrombotic episodes. Guidelines developed by clinical organisations attempt to provide evidence-based recommendations to clinicians.

METHODS

This narrative review evaluated the current available literature in relation to the available guidelines, to evaluate whether the current major guidelines reflect the evidence base. All major clinical guidelines were collated through database searching, alongside the relevant clinical studies.

PRINCIPAL FINDINGS

The promotion of a multi-modal approach, combining mechanical and chemical prophylaxis, does appear to be well validated, with mechanical prophylaxis offering positive clinical effects with little negative clinical consequence. Within the current guidelines surrounding VTE prevention in the elective-THA patient, there does appear to be a lack of prescription in relation to risk stratification and adopting personalised approaches for specific patient subsets.

CONCLUSION

We suggest moving away from protocolisation of VTE prevention, given the evidence base is not fully developed to allow a 'one-size-fits-all' approach.

摘要

引言

择期全髋关节置换术后静脉血栓栓塞是一种公认的并发症,可导致致命性肺栓塞、血栓后综合征和复发性血栓事件。临床组织制定的指南试图为临床医生提供基于证据的建议。

方法

本叙述性综述评估了与现有指南相关的当前可用文献,以评估当前主要指南是否反映了证据基础。通过数据库检索整理所有主要临床指南以及相关临床研究。

主要发现

推广机械和药物联合预防的多模式方法似乎得到了充分验证,机械预防具有积极的临床效果且几乎没有负面临床后果。在当前关于择期全髋关节置换术患者预防静脉血栓栓塞的指南中,对于风险分层和针对特定患者亚组采用个性化方法的规定似乎不足。

结论

鉴于证据基础尚未充分发展到足以采用“一刀切”的方法,我们建议不再对静脉血栓栓塞预防进行标准化。

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