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巴西肺栓塞药物治疗指南。巴西胸科协会基于GRADE方法制定的官方文件。

Brazilian guidelines for the pharmacological treatment of pulmonary embolism. Official document of the Brazilian Thoracic Association based on the GRADE methodology.

作者信息

Amado Veronica Moreira, Fernandes Caio Júlio César Dos Santos, Salibe-Filho William, Gazzana Marcelo Basso, Rocha Ana Thereza, Yoo Hugo Hyung Bok, Bernardo Wanderley Marques, Tanni Suzana

机构信息

. Universidade de Brasília - UnB - Brasília (DF) Brasil.

. Grupo de Circulação Pulmonar, Departamento de Cardiopneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil.

出版信息

J Bras Pneumol. 2025 Jun 13;51(2):e20240314. doi: 10.36416/1806-3756/e20240314. eCollection 2025.

DOI:10.36416/1806-3756/e20240314
PMID:40531728
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12401105/
Abstract

Venous thromboembolism (VTE) is the third most common acute cardiovascular syndrome after acute myocardial infarction and stroke. In recent years, there has been an increase in the incidence of VTE, related to population aging and common comorbidities in the elderly, including chronic cardiorespiratory disease and cancer. On the other hand, disease-related mortality, particularly for pulmonary embolism (PE), shows a decreasing trend, which can be explained by improvements in diagnostic imaging, advances in available therapies, and greater adherence to patient management protocols. The guidelines presented here provide recommendations for the pharmacological treatment of PE in Brazil, on the basis of scientific evidence and with a focus on common practical issues. Six Patient, Intervention, Comparison, and Outcome questions were developed by a group of experts on the topic. Systematic reviews of randomized clinical trials were conducted for each question, with meta-analyses being performed when possible. The level of evidence and strength of recommendation were defined in accordance with the Grading of Recommendations Assessment, Development, and Evaluation approach. With these guidelines, we expect to provide relevant, up-to-date information on the pharmacological treatment of PE.

摘要

静脉血栓栓塞症(VTE)是仅次于急性心肌梗死和中风的第三大常见急性心血管综合征。近年来,VTE的发病率有所上升,这与人口老龄化以及老年人常见的合并症有关,包括慢性心肺疾病和癌症。另一方面,疾病相关的死亡率,尤其是肺栓塞(PE)的死亡率呈下降趋势,这可以通过诊断成像的改善、现有治疗方法的进步以及对患者管理方案的更严格遵守来解释。此处呈现的指南基于科学证据并聚焦于常见实际问题,为巴西PE的药物治疗提供建议。一组该主题的专家提出了六个患者、干预措施、对照和结局问题。针对每个问题进行了随机临床试验的系统评价,并在可能的情况下进行荟萃分析。证据水平和推荐强度根据推荐评估、制定和评价分级方法来定义。通过这些指南,我们期望提供有关PE药物治疗的相关、最新信息。

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本文引用的文献

1
Direct Oral Anticoagulants vs Low-Molecular-Weight Heparin and Recurrent VTE in Patients With Cancer: A Randomized Clinical Trial.直接口服抗凝剂与低分子肝素在癌症患者中的疗效比较:一项随机临床试验。
JAMA. 2023 Jun 13;329(22):1924-1933. doi: 10.1001/jama.2023.7843.
2
Mortality and bleeding associated with the management of sub-massive pulmonary embolism: a systematic review and Bayesian network meta-analysis.亚大块肺栓塞治疗相关的死亡率和出血事件:系统评价和贝叶斯网络荟萃分析。
Sci Rep. 2023 May 3;13(1):7169. doi: 10.1038/s41598-023-34348-9.
3
An Update in Anticoagulant Therapy for Patients with Cancer-Associated Venous Thromboembolism.癌症相关静脉血栓栓塞症患者抗凝治疗的最新进展。
Curr Oncol Rep. 2023 May;25(5):425-432. doi: 10.1007/s11912-023-01384-7. Epub 2023 Mar 16.
4
Catheter-directed therapies for the treatment of high risk (massive) and intermediate risk (submassive) acute pulmonary embolism.经导管治疗高危(大块)和中危(次大块)急性肺栓塞。
Cochrane Database Syst Rev. 2022 Aug 8;8(8):CD013083. doi: 10.1002/14651858.CD013083.pub2.
5
Risk Stratification in Patients with Acute Pulmonary Embolism: Current Evidence and Perspectives.急性肺栓塞患者的风险分层:当前证据与展望
J Clin Med. 2022 Apr 30;11(9):2533. doi: 10.3390/jcm11092533.
6
Hospitalizations for pulmonary embolism in Brazil (2008-2019): an ecological and time series study.巴西肺栓塞住院治疗情况(2008-2019 年):一项生态学和时间序列研究。
J Bras Pneumol. 2022 Apr 22;48(3):e20210434. doi: 10.36416/1806-3756/e20210434. eCollection 2022.
7
Comparative efficacy and safety of oral anticoagulants for the treatment of venous thromboembolism in the patients with different renal functions: a systematic review, pairwise and network meta-analysis.不同肾功能患者口服抗凝药物治疗静脉血栓栓塞症的疗效和安全性比较:系统评价、成对比较和网络荟萃分析。
BMJ Open. 2022 Feb 21;12(2):e048619. doi: 10.1136/bmjopen-2021-048619.
8
Rivaroxaban vs Dalteparin in Cancer-Associated Thromboembolism: A Randomized Trial.利伐沙班与达肝素治疗癌症相关血栓栓塞的随机试验
Chest. 2022 Mar;161(3):781-790. doi: 10.1016/j.chest.2021.09.037. Epub 2021 Oct 8.
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Thromb Haemost. 2022 May;122(5):857-866. doi: 10.1055/a-1653-4699. Epub 2021 Oct 31.
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Thromb Haemost. 2022 May;122(5):796-807. doi: 10.1055/s-0041-1735194. Epub 2021 Sep 16.