Godier Anne, Lasne Dominique, Pernod Gilles, Blais Normand, Bonhomme Fanny, Bounes Fanny, Bourguignon Alex, Cohen Ariel, de Maistre Emmanuel, Fontana Pierre, Galanaud Jean-Philippe, Huet Delphine Garrigue, Godon Alexandre, Gouin-Thibault Isabelle, Jebara Samia, Laporte Silvy, Lecompte Thomas, Longrois Dan, H Levy Jerrold, Le Gal Grégoire, Gruel Yves, Mansour Alexandre, Martin Anne-Céline, Mazighi Mikael, Morange Pierre-Emmanuel, Motte Serge, Mullier François, Nguyen Philippe, Rosencher Nadia, Roullet Stéphanie, Roy Pierre-Marie, Schved Jean-François, Sevestre Marie-Antoinette, Sié Pierre, Susen Sophie, Tacquard Charles, Vincentelli André, Zufferey Paul, Mismetti Patrick, Albaladejo Pierre
Université Paris Cité, Service d'anesthésie-réanimation, AP-HP, Hôpital Georges Pompidou, UMRS_1140, F-75006 Paris, France.
Laboratoire d'hématologie générale, AP-HP, Hôpital Necker-Enfants Malades, INSERM UMRS_1176, Paris, France.
Anaesth Crit Care Pain Med. 2024 Oct 22:101446. doi: 10.1016/j.accpm.2024.101446.
Any surgical procedure carries a risk for venous thromboembolism (VTE), albeit variable. Improvements in medical and surgical practices and the shortening of care pathways due to the development of day surgery and enhanced recovery after surgery, have reduced the perioperative risk for VTE.
A collaborative working group of experts in perioperative haemostasis updated in 2024 the recommendations for the Prevention of perioperative venous thromboembolism published in 2011.
The addressed questions were defined by 40 experts (GIHP, SFAR, SFTH and SFMV) and formulated in a PICO format. They performed the literature review and formulated recommendations according to the Grading of GRADE system. Recommendations were then validated by a vote determining the strength of each recommendation. Of note, these recommendations do not cover all surgical specialties. Especially, thromboprophylaxis in cardiac surgery, neurosurgery and obstetrics is not addressed.
78 recommendations were formalized into 17 sections, including patient-related VTE risk factors, types of surgery, extreme body weight, renal impairment, mechanical prophylaxis, distal deep vein thrombosis; 27 were found to have a high level of evidence (GRADE 1) and 41 a low level of evidence (GRADE 2) and 10 were expert opinion. All had strong agreement among the experts.
These guidelines help to weigh the perioperative risk for VTE (which includes the risk associated to surgery and the patient-related risk) against the adverse effects of thromboprophylaxis, either pharmacological or mechanical. This includes particularly the bleeding risk induced by antithrombotic drugs as well as costs.
任何外科手术都有静脉血栓栓塞（VTE）的风险，尽管风险程度各不相同。由于日间手术的发展和术后加速康复，医疗和外科实践的改进以及护理路径的缩短，降低了围手术期VTE的风险。
一个围手术期止血专家协作工作组于2024年更新了2011年发布的围手术期静脉血栓栓塞预防建议。
由40位专家（GIHP、SFAR、SFTH和SFMV）确定要解决的问题，并以PICO格式进行表述。他们进行了文献综述，并根据GRADE系统的分级制定了建议。然后通过投票确定每项建议的强度来验证建议。值得注意的是，这些建议并不涵盖所有外科专科。特别是，未涉及心脏手术、神经外科手术和产科手术中的血栓预防。
78项建议被整理为17个部分，包括与患者相关的VTE危险因素、手术类型、极端体重、肾功能损害、机械预防、远端深静脉血栓形成；其中27项有高证据级别（GRADE 1），41项有低证据级别（GRADE 2），10项为专家意见。所有建议在专家中都有强烈共识。
这些指南有助于权衡围手术期VTE的风险（包括与手术相关的风险和与患者相关的风险）与血栓预防的不良反应，无论是药物预防还是机械预防。这尤其包括抗血栓药物引起的出血风险以及成本。
