Institute of Health Systems Science-Feinstein Institutes for Medical Research, Manhasset, New York, USA.
The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hemptead, New York, USA.
J Thromb Haemost. 2022 Oct;20(10):2226-2236. doi: 10.1111/jth.15809. Epub 2022 Jul 29.
Despite the emergence of high quality randomized trial data with the use of antithrombotic agents to reduce the risk of thromboembolism, end-organ failure, and possibly mortality in patients with coronavirus disease 2019 (COVID-19), questions still remain as to optimal patient selection for these strategies, the use of antithrombotics in outpatient settings and in-hospital settings (including critical care units), thromboprophylaxis in special patient populations, and the management of acute thrombosis in hospitalized COVID-19 patients. In October 2021, the International Society on Thrombosis and Haemostasis (ISTH) formed a multidisciplinary and international panel of content experts, two patient representatives, and a methodologist to develop recommendations on treatment with anticoagulants and antiplatelet agents for COVID-19 patients. The ISTH Guideline panel discussed additional topics to be well suited to a non-Grading of Recommendations Assessment, Development, and Evaluation (GRADE) for Good Practice Statements (GPS) to support good clinical care in the antithrombotic management of COVID-19 patients in various clinical settings. The GPS panel agreed on 17 GPS: 3 in the outpatient (pre-hospital) setting, 12 in the hospital setting both in non-critical care (ward) as well as intensive care unit settings, and 2 in the immediate post-hospital discharge setting based on limited evidence or expert opinion that supports net clinical benefit in enacting the statements provided. The antithrombotic therapies discussed in these GPS should be available in low- and middle-income countries.
尽管出现了高质量的随机临床试验数据，表明使用抗血栓药物可以降低 2019 冠状病毒病（COVID-19）患者发生血栓栓塞、终末器官衰竭和死亡的风险，但对于这些策略的最佳患者选择、抗血栓药物在门诊和住院环境（包括重症监护病房）中的使用、特殊患者人群中的血栓预防以及住院 COVID-19 患者急性血栓的处理等问题仍存在疑问。2021 年 10 月，国际血栓与止血学会（ISTH）成立了一个多学科和国际化的专家组，成员包括两名患者代表和一名方法学家，旨在制定 COVID-19 患者使用抗凝和抗血小板药物的治疗建议。ISTH 指南小组讨论了其他适合非推荐评估、制定和评估（GRADE）良好实践声明（GPS）的主题，以支持在各种临床环境中对 COVID-19 患者进行抗血栓管理的良好临床护理。GPS 小组就 17 个 GPS 达成一致意见：3 个用于门诊（院前）环境，12 个用于医院环境，包括非重症监护病房（病房）和重症监护病房环境，2 个用于医院出院后环境，依据的是有限的证据或专家意见，支持在实施这些声明时具有净临床获益。这些 GPS 中讨论的抗血栓治疗方法应在中低收入国家中可用。
