Flinkier Ariane, Dewapura Suwandi, Tran Hai, Yin Zoe, Tran Nghiep, Berman Jordan, Ratnasekara Vidhura, Raykateeraroj Nattaya, Fink Michael, Lee Dong Kyu, Weinberg Laurence
Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia.
Department of Surgery, St Vincent's Hospital (Melbourne) Limited, Fitzroy, Victoria, Australia.
BMJ Open. 2025 Jun 30;15(6):e092284. doi: 10.1136/bmjopen-2024-092284.
Haemostasis, a process involving platelet activation, platelet aggregation and coagulation, poses intricate clinical challenges for clinicians. There remains significant national variability in thromboprophylaxis protocols, which are used in 77-82% of surgical cases in Australia. There is also increasing concern focused on the development of antiplatelet resistance. Given an apparent lack of standardised approaches to haemostasis, these decisions frequently require clinician discretion and can result in suboptimal outcomes. To optimise patient management, all available therapeutic agents should be considered. Current standards may need to be revised accordingly.Dextrans are polysaccharides with perioperative significance in haemostasis. Although the proposed mechanisms of dextran action are multifactorial, these agents may have a significant impact in cases of trauma, reconstructive surgery, transplantation and vascular surgery. However, a suspected deficit in the quality of the literature, and therefore clinical standardisation, raises concerns for optimal incorporation into practice.Accordingly, we plan to examine both peer-reviewed articles and 'grey' literature that considers the indications, efficacy and complications associated with the clinical use of dextrans to promote haemostasis. The primary objective of this scoping review will be to analyse and map the existing literature on the use of dextrans in both operative and non-operative settings and provide insight that will bridge the current knowledge gap and guide future research initiatives.
The study and literature search will be performed in accordance with recommendations adapted for scoping reviews in alignment with Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews standards. A thorough and systematic investigation will be undertaken across several electronic databases, including EMBASE, the Cochrane Library and MEDLINE; additional studies will be accessed and examined by reference tracking. All relevant research published before 11 March 2024 will be reviewed for appropriateness of inclusion. Two researchers will perform data screening and extraction of relevant information. Study observations will be presented in a descriptive manner using a mixed methods and narrative approach.
Ethics approval was not required for this study. The results will be disseminated through publication in open-access peer-reviewed journals, established professional networks and conference presentations.
止血是一个涉及血小板激活、血小板聚集和凝血的过程，给临床医生带来了复杂的临床挑战。在澳大利亚，77%至82%的外科手术病例使用了血栓预防方案，而这些方案在全国范围内仍存在显著差异。人们也越来越关注抗血小板抵抗的发展。鉴于止血方面明显缺乏标准化方法，这些决策常常需要临床医生自行判断，可能导致不理想的结果。为了优化患者管理，应考虑所有可用的治疗药物。当前标准可能需要相应修订。右旋糖酐是对围手术期止血有重要意义的多糖。尽管右旋糖酐作用的推测机制是多因素的，但这些药物可能对创伤、重建手术、移植和血管手术病例产生重大影响。然而，由于怀疑文献质量存在缺陷，进而影响临床标准化，这引发了关于能否最佳地应用于实践的担忧。
因此，我们计划审查同行评审文章和“灰色”文献，这些文献探讨了与右旋糖酐临床应用以促进止血相关的适应症、疗效和并发症。本范围综述的主要目标将是分析和梳理关于右旋糖酐在手术和非手术环境中使用的现有文献，并提供见解，以弥合当前的知识差距并指导未来的研究计划。
本研究和文献检索将按照适用于范围综述的建议进行，符合系统评价和Meta分析扩展版的首选报告项目标准。将对包括EMBASE、Cochrane图书馆和MEDLINE在内的多个电子数据库进行全面系统的调查；通过参考文献追踪获取并审查其他研究。将审查2024年3月11日前发表的所有相关研究是否适合纳入。两名研究人员将进行数据筛选和相关信息提取。研究观察结果将采用混合方法和叙述方法进行描述性呈现。
本研究无需伦理批准。研究结果将通过发表在开放获取的同行评审期刊、已建立的专业网络以及会议报告中进行传播。
