人工关节置换术后静脉血栓预防性治疗指南的新进展

目的:综述目前对人工关节置换术后静脉血栓形成预防性治疗的最新观点。方法:通过网络检索CNKI和Pub Med数据库等关于人工关节置换术后预防性治疗静脉血栓形成的文章,在标题和摘要中主要以"total joint arthroplasty;venous thromboembolism;prophylaxis"为关键词。结果:三份权威临床指南(ACCP、AAOS、NICE)最近均有更新;更新后的三者都认为人工关节置换术后对静脉血栓形成的预防性治疗是必要的;都建议对静脉血栓形成高危患者进行药物结合机械的综合预防措施;认为单独的机械预防同低分子肝素一样有效;都肯定了新口服抗凝药物及fondaparinux的临床疗效;在不推荐对无临床症状的患者行超声检查、不推荐预防性放置下腔静脉滤网问题上达成了部分共识;但在最合适的药物治疗方案选择、开始治疗的时间、治疗的持续时间及抗血小板药物的地位问题上存在争议,甚至意见完全相左。结论:目前的指南虽然部分意见尚不统一,但基本原则已达成共识。

The Guides' New Steps for Venous Thromboembolic Event Prophylaxis in Total Joint Arthroplasty

To summarize the recent veiws on venous thromboembolism (VTE) prophylaxis in total joint arthroplasty. CNKI database and PubMed database were searched through Web with the key words of "total joint arthroplasty, venous thromboembolism, prophylaxis". Three sets of guidelines(National Institute for Health and Clinical Excellence (NICE), American College of Chest Physicians (ACCP) and American Academy of Orthopaedic Surgeons (AAOS)) have recently been updated. The guidelines have points in common: prophylaxis is necessary; it is recommended to combine mechanical and pharmacological prophylaxis in patients at high risk of VTE, establishing isolated mechanical measures as effective as low molecular weight heparins (LMWH); the new oral anticoagulants (NOAC) and fondaparinux are effective drugs. There is some consensus in recommending regional anaesthesia, in advising against echography studies in asymptomatic patients, and in the promotion of early mobilisation of the patient. There are however, significant discrepancies about which therapy is the most appropriate, the ideal time of initiation of drug therapy and its duration, as well as discontinuation or not of antiplatelet drugs, considering aspirin. The guides'' recent veiws on venous thromboembolismprophylaxis in total joint arthroplasty have been agreed on the most of basic principles.