骨科大手术后VTE预防国内外指南及质量评价和NOAC的应用  

Domestic and Foreign Guidelines and Quality Assessment of VTE Prevention after Major Orthopedic Surgery and Application of NOAC

作　　者：徐娟 张久星[1] 刘娟[1] 石园[1] 乔艳[1] 刘爽[1] 邹莉[1] 刘高峰[1] XU Juan;ZHANG Jiu-xing;LIU Juan;SHI Yuan;QIAO Yan;LIU Shuang;ZOU Li;LIU Gao-feng(Department of Pharmacy,the Second Affliated Hospital of Harbin Medical University,Key Laboratory of University in Heilongjiang Province,Harbin Heilongjiang 150086,China)

机构地区：[1]哈尔滨医科大学附属第二医院药学部,黑龙江省高校重点实验室,黑龙江哈尔滨150086

出　　处：《药品评价》2018年第18期9-12,17,共5页Drug Evaluation

基　　金：中国健康促进基金会“新型口服抗凝药物的发展、评价与选用”科研课题;项目编号:会字(2016)第99号

摘　　要：目的:系统评价骨科大手术后静脉血栓栓塞症(Venous thromboembolism,VTE)预防的国内外相关指南,总结指南中对新型口服抗凝药(Novel oral anticoagulants,NOAC)的推荐意见,为指南的修订和临床治疗提供参考依据。方法:检索国内外相关数据库及专业网站,总结骨科大手术后VTE预防的相关指南,用AGREE II指南质量评价工具进行质量评价,并总结NOAC在指南中的推荐。结果:共检索筛选出国内外相关指南7个,经质量评价后,推荐使用的指南有4个,建议修订后使用的指南有1个,不推荐使用的指南有2个。结论:推荐参考的指南有英国国家卫生和临床技术优化研究所(National institute for health and care excellence,NICE)发表的3个指南和美国骨科医师学会(American academy of orthopaedic surgeons,AAOS)指南。用于骨科大手术后VTE预防的NOAC有达比加群酯、利伐沙班和阿哌沙班,其在有效性和安全性方面优于传统的抗凝药物。Objective： To systematically summarize the relevant domestic and foreign guidelines for prevention of VTE after major orthopedic surgery, and sum up the recommendations of NOAC, in order to provide reference for guideline revision and clinical treatment. Methods： The relevant guidelines were obtained by searching the domestic and foreign databases and related professional websites, and etc. Quality evaluation of the guidelines was performed using the AGREE II guideline quality assessment tool, and NOAC recommendation was summarized. Results： A total of 7 guidelines were screened. After quality evaluation, 4 of them were recommended to guide, 1 for revised, and 2 for unguided. Conclusion： The three guidelines published by the National Institute for Health and Clinical Technology （NICE） and the guideline by American Association of Orthopaedic Surgeons （AAOS） were recommended. The NOAC for prevention of VTE after major orthopedic surgery are dabigatran, rivaroxaban, and apixaban, which are superior to conventional anticoagulants in terms of ef？cacy and safety.

关 键 词：骨科大手术 VTE 指南 NOAC 新型口服抗凝药 

分 类 号：R982[医药卫生—药品]