Department of Gastroenterology and Hepatology, Puerta de Hierro University Hospital, IDIPHISA, CIBERehd, Madrid, Spain.
Department of Hospital Pharmacy, University Hospital Son Espases, Palma, Spain.
Gastroenterol Hepatol. 2024 Jan;47(1):32-50. doi: 10.1016/j.gastrohep.2023.03.008. Epub 2023 Apr 5.
The lack of consensus and specific guidelines, and the introduction of new treatments in thrombocytopenia management in liver cirrhosis patients, required a series of recommendations by experts to improve knowledge on this disease. This study's aim was to improve the knowledge around thrombocytopenia in liver cirrhosis patients, in order to contribute to the generation of future evidence to improve the management of this disease.
A modified version of the RAND/UCLA appropriateness method was used. The scientific committee, a multidisciplinary team of 7 experts in managing thrombocytopenia in liver cirrhosis patients, identified the expert panel, and participated in elaborating the questionnaire. Thirty experts from different Spanish institutions were invited to answer a 48-item questionnaire covering 6 areas on a nine-point Likert scale. Two rounds were voted. The consensus was obtained if >77.7% of panelists reached agreement or disagreement.
A total of 48 statements were developed by the scientific committee and then voted by the experts, resulting in 28 defined as appropriate and completely necessary, relating to evidence generation (10), care circuit, (8), hemorrhagic risk assessment, decision-making and diagnostic tests (14), professionals' role and multidisciplinary coordination (9) and patient education (7).
This is the first consensus in Spain on the management of thrombocytopenia in liver cirrhosis patients. Experts indicated several recommendations to be carried out in different areas that could help physicians make better decisions in their clinical practice.
由于在肝硬化患者血小板减少症管理方面缺乏共识和具体指南，并且引入了新的治疗方法，因此需要专家提出一系列建议，以提高对这种疾病的认识。本研究旨在提高对肝硬化患者血小板减少症的认识，以便为未来改善这种疾病的管理提供更多证据。
采用改良版 RAND/UCLA 适宜性方法。科学委员会，即一个由 7 名管理肝硬化患者血小板减少症的多学科专家组成的团队，确定了专家小组，并参与了问卷的制定。邀请来自西班牙不同机构的 30 名专家回答涵盖 6 个领域的 48 个 9 点李克特量表问题。进行了两轮投票。如果 >77.7%的小组成员达成一致或不一致，则达成共识。
科学委员会制定了总共 48 项陈述，然后由专家进行投票，其中 28 项被定义为合适且完全必要的陈述，涉及证据生成（10 项）、护理流程（8 项）、出血风险评估、决策和诊断测试（14 项）、专业人员的角色和多学科协调（9 项）以及患者教育（7 项）。
这是西班牙首次针对肝硬化患者血小板减少症管理达成的共识。专家们指出了在不同领域需要开展的多项建议，这有助于医生在临床实践中做出更好的决策。
