新型冠状病毒感染住院患者血栓预防和抗凝管理指南  

Practice guidelines of thromboprophylaxis and management of anticoagulation in hospitalized patients with COVID-19

作　　者：《新型冠状病毒感染住院患者血栓预防和抗凝管理指南》工作组 中华医学会呼吸病学分会肺栓塞与肺血管病学组 中国医师协会呼吸医师分会肺栓塞与肺血管病工作委员会 全国肺栓塞与肺血管病防治协作组 全国肺栓塞和深静脉血栓形成防治能力建设项目专家委员会 翟振国[2] 陈耀龙[3] 王辰[4] 胡成平[5] 刘鹏[6] 夏磊[7] Working Group on Guidelines for Thromboprophylaxis and Management of Anticoagulation in Hospitalized Patients with COVID-19;Pulmonary Embolism&Pulmonary Vascular Diseases Group of the Chinese Thoracic Society;Pulmonary Embolism&Pulmonary Vascular Disease Working Committee of Chinese Association of Chest Physicians;National Cooperation Group on Prevention&Treatment of Pulmonary Embolism&Pulmonary Vascular Disease;National Program Office for Prevention Treatment of Pulmonary Embolism&Deep Vein Thrombosis,China Grade Center;Zhai Zhenguo;Chen Yaolong;Wang Chen(不详;Department of Pulmonary and Critical Care Medicine,Center of Respiratory Medicine,China-Japan Friendship Hospital,National Center for Respiratory Medicine,Beijing 100029,China;Research Unit of Evidence-Based Evaluation and Guidelines,Chinese Academy of Medical Sciences,School of Basic Medical Sciences,Lanzhou University,Lanzhou 730000,China;Chinese Academy of Medical Sciences,Peking Union Medical,Beijing 100730,China)

机构地区：[1]不详 [2]中日友好医院呼吸中心呼吸与危重症医学科国家呼吸医学中心,北京100029 [3]兰州大学基础医学院循证医学中心,中国医学科学院循证评价与指南研究创新单元,兰州730000 [4]中国医学科学院北京协和医学院,北京100730 [5]中南大学湘雅医院呼吸与危重症医学科 [6]中日友好医院心脏血管外科 [7]中日友好医院医务处,国家呼吸医学中心实验研究部

出　　处：《中华医学杂志》2023年第12期863-885,共23页National Medical Journal of China

基　　金：重大呼吸系统疾病高水平临床研究和规范化诊疗方案推广(2022-NHLHCRF-LX-01-0108、2022-NHLHCRF-LX-01-0203);中国医学科学院医学与健康科技创新工程(2020-I2M-A-022、2021-I2M-1-049、2021-I2M-1-061);国家重点研发计划(2016YFC0905600)

摘　　要：新型冠状病毒感染(COVID-19)可通过多种机制引发血栓并发症,其中静脉血栓栓塞症(VTE)是导致COVID-19住院患者死亡或预后不佳的重要原因之一。采用合理的风险评估模型对COVID-19患者进行VTE及出血风险评估,并按照风险级别实施规范的预防措施可显著改善COVID-19患者血栓相关不良预后。然而在目前的临床实践中,如何根据COVID-19患者严重程度及具体病情选择恰当的预防方式、抗凝方案、剂量和疗程,动态平衡血栓和出血风险,仍有很大的提升空间。近年来,国际已发布系列COVID-19合并VTE相关权威指南及高质量循证医学研究证据,基于此,为更好地指导我国医护人员的临床实践,经过多学科专家研讨和德尔菲专家论证,工作组牵头制订了《新型冠状病毒感染住院患者血栓预防和抗凝管理指南》,针对COVID-19引起的血栓风险和预防策略、住院患者的抗凝管理、血栓诊治、特殊人群的抗凝管理、抗病毒和抗炎药物与抗凝治疗药物的相互作用和调整策略、出院后随访等诸多方面的临床核心问题进行了阐述,以期明确对不同临床分型COVID-19患者及特殊人群的合理预防和抗凝管理策略,为我国COVID-19患者VTE防治提供推荐意见和临床指导。Corona virus disease 2019(COVID-19)can lead to thrombotic complications through multiple mechanisms.Venous thromboembolism(VTE)is one of the most important causes of death or poor prognosis in hospitalized patients with COVID-19.The prognosis of thrombosis in COVID-19 patients can be improved with VTE and bleeding risk assessment,as well as appropriate VTE prophylaxis.However,in current clinical practice,there still is much room for progress in choose of appropriate prevention methods,anticoagulant regimens,doses,and courses based on the severity and specific condition of COVID-19 patients and dynamically balancing the risk of thrombosis and bleeding.In the past three years,a series of authoritative guidelines related to VTE and COVID-19 and high-quality,evidence-based medical research evidence have been released both in domestic and internationally.Based on this,in order to better guide the clinical practice in China,multi-discipline expert discussions and Delphi expert demonstrations formulated the"Thromboprophylaxis and management of anticoagulation in hospitalized patients with COVID-19:an update of the CTS guidelines",aiming to address the issues of thrombosis risk and prevention strategies caused by COVID-19,anticoagulant management of hospitalized patients,diagnosis and treatment of thrombosis,anticoagulant management of special populations,interaction and adjustment strategies of antiviral and anti-inflammatory drugs and anticoagulant drugs,follow-up after discharge and many other aspects of clinical situations.Recommendations and clinical guidelines are provided for appropriate thromboprophylaxis and anticoagulation management strategies for VTE in patients with COVID-19.

关 键 词：血栓栓塞 新型冠状病毒感染 血栓预防 抗凝 肝素 

分 类 号：R511[医药卫生—内科学]