Delgado-Flores Carolina J, García-Gomero David, Pinedo-Castillo Liseth, Taype-Rondan Alvaro
Carrera de Farmacia y Bioquímica, Facultad de Ciencias de la Salud Universidad Científica del Sur Lima Perú.
Facultad de Medicina "San Fernando" Universidad Nacional Mayor de San Marcos Lima Peru.
Health Sci Rep. 2023 Jul 13;6(7):e1326. doi: 10.1002/hsr2.1326. eCollection 2023 Jul.
Hemophilia clinical practice guidelines (CPGs) play a vital role in guiding healthcare professionals' decisions. However, the quality and recommendations of CPGs for hemophilia may vary. This study aimed to assess the methodological quality of hemophilia CPGs published between 2017 and 2021 and compare their recommendations for prophylaxis using clotting factor concentrate.
We conducted a comprehensive search for relevant CPGs in PubMed, TripDatabase, Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) International Guidelines Database, Google Scholar, and Google. We used the AGREE-II instrument to assess the methodological quality of each CPG and compared their recommendations for prophylaxis.
Of the 11 CPGs that met the inclusion criteria, 5/11 were developed in upper-middle-income countries, and 6/11 used the GRADE methodology. The primary prophylaxis dose recommendations varied among the CPGs, with 4/11 recommending a low dose, 6/11 recommending an intermediate or high dose, and 1/11 not issuing a recommendation. However, only 2/11 CPGs provided justification for their recommendations on initiation and dose, and no economic evaluations were conducted to support these recommendations.
The quality of hemophilia CPGs is not optimal, with inconsistent recommendations for prophylaxis and a lack of justification for these recommendations. To ensure evidence-based and trustworthy recommendations, there is a need for transparency and improvement in the decision-making process of hemophilia CPGs.
血友病临床实践指南（CPGs）在指导医疗保健专业人员的决策中起着至关重要的作用。然而，血友病CPGs的质量和建议可能存在差异。本研究旨在评估2017年至2021年期间发表的血友病CPGs的方法学质量，并比较它们关于使用凝血因子浓缩物进行预防的建议。
我们在PubMed、Trip数据库、推荐分级、评估、制定与评价（GRADE）国际指南数据库、谷歌学术和谷歌上全面搜索了相关的CPGs。我们使用AGREE-II工具评估每个CPG的方法学质量，并比较它们关于预防的建议。
在符合纳入标准的11份CPGs中，5/11是在中高收入国家制定的，6/11使用了GRADE方法。各CPGs之间主要预防剂量建议各不相同，4/11建议低剂量，6/11建议中或高剂量，1/11未给出建议。然而，只有2/11的CPGs为其关于起始和剂量的建议提供了理由，并且没有进行经济评估来支持这些建议。
血友病CPGs的质量并不理想，预防建议不一致且缺乏对这些建议的论证。为确保基于证据且可靠的建议，血友病CPGs的决策过程需要透明度和改进。
