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创伤患者静脉血栓栓塞预防的新型治疗药物:实施创伤最佳静脉血栓栓塞预防共识会议的研究结果。

Novel therapeutic medications for venous thromboembolism prevention in trauma patients: Findings from the Consensus Conference to Implement Optimal Venous Thromboembolism Prophylaxis in Trauma.

机构信息

From the R Adams Cowley Shock Trauma Center (N.K.D.), University of Maryland; Division of Acute Care Surgery, Department of Surgery (E.R.H.), Department of Anesthesiology and Critical Care Medicine (E.R.H.), and Department of Emergency Medicine (E.R.H.), The Johns Hopkins University School of Medicine; The Armstrong Institute for Patient Safety and Quality (E.R.H.), Johns Hopkins Medicine; Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health (E.R.H.), Baltimore, Maryland; Coalition for National Trauma Research (M.A.P.), San Antonio, Texas; Division of Trauma, Surgical Critical Care, and Burns, and Acute Care Surgery, Department of Surgery (T.W.C.), University of California San Diego School of Medicine, San Diego, California; Division of Acute Care Surgery (A.L.T.), Rutgers-Robert Wood Johnson School of Medicine, New Brunswick, New Jersey; Division of Acute Care Surgery, Department of Surgery (B.A.C.), McGovern Medical School, Memorial Hermann Hospital, Houston, Texas; and Department of Surgery (E.J.L.), Cedars-Sinai Medical Center, Los Angeles, California.

出版信息

J Trauma Acute Care Surg. 2023 Mar 1;94(3):479-483. doi: 10.1097/TA.0000000000003853. Epub 2022 Dec 6.

Abstract

Trauma patients are at high risk for venous thromboembolism (VTE). Despite evidence-based guidelines and concerted efforts in trauma centers to implement optimal chemoprophylaxis strategies, VTE remains a frequent diagnosis in trauma patients. Current chemoprophylaxis strategies largely focus on the subcutaneous injection of low-molecular-weight heparin, which is administered twice daily. Novel approaches to pharmacologic VTE prophylaxis have the potential to reduce VTE rates by improving patient compliance through oral administration or through their ability to target alternative pathways that mediate thrombosis. While novel pharmacologic VTE prophylaxis strategies have been studied in nontrauma patients, there is a paucity of literature in trauma patients where the risk of thrombosis versus hemorrhage must be carefully considered. As a component of the 2022 Consensus Conference to Implement Optimal VTE Prophylaxis in Trauma, this review provides an update of the novel chemoprophylaxis agents for potential use in trauma patients. Here, we will consider the relative risks and benefits related to the use of these drugs, evaluate the current literature in nontrauma patients, and consider future directions that could potentially improve posttrauma VTE prophylaxis.

摘要

创伤患者有发生静脉血栓栓塞症(VTE)的高风险。尽管有循证指南和创伤中心的协同努力来实施最佳的化学预防策略,但 VTE 在创伤患者中仍然是常见的诊断。目前的化学预防策略主要集中在皮下注射低分子量肝素,每日两次。通过口服给药或通过靶向介导血栓形成的替代途径的能力,新型药理学 VTE 预防策略有可能通过提高患者的依从性来降低 VTE 发生率。虽然新型药理学 VTE 预防策略已在非创伤患者中进行了研究,但在创伤患者中,血栓形成与出血的风险必须仔细考虑,相关文献却很少。作为 2022 年实施创伤最佳 VTE 预防共识会议的一部分,本综述提供了潜在用于创伤患者的新型化学预防剂的更新信息。在这里,我们将考虑与使用这些药物相关的相对风险和益处,评估非创伤患者的当前文献,并考虑可能改善创伤后 VTE 预防的未来方向。

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