新型冠状病毒感染住院患者血栓预防和抗凝管理临床路径与实施规范  

Thromboprophylaxis and management of anticoagulation in hospitalized patients with COVID-19:clinical pathway and practices

作　　者：《新型冠状病毒感染住院患者血栓预防和抗凝管理临床路径与实施规范》工作组 中华医学会呼吸病学分会 中国医师协会呼吸医师分会 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 季颖群 翟振国[3] 王辰[4] 杨媛华[5] 熊长明 胡成平[7] 柳志红 陈耀龙[8] 夏磊[9] Working Group on Clinical Pathway and Practices for Thromboprophylaxis and Management of Anticoagulation in Hospitalized Patients with COVID-19;Chinese Thoracic Society;Chinese Association of Chest Physicians;National Cooperation Group on Prevention&Treatment of Pulmonary Embolism&Pulmonary Vascular Disease;National Program Ofice for Prevention Treatment of Pulmonary Embolism&Deep Vein Thrombosis,China Grade Center

机构地区：[1]不详 [2]上海市东方医院(同济大学附属东方医院)呼吸与危重症医学科,上海200120 [3]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 [4]中国医学科学院、北京协和医学院,北京100730 [5]首都医科大学附属北京朝阳医院呼吸与危重症医学科 [6]中国医学科学院阜外医院肺血管病诊治中心 [7]中南大学湘雅医院呼吸与危重症医学科 [8]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 [9]中日友好医院医务处国家呼吸医学中心实验研究部

出　　处：《中华结核和呼吸杂志》2023年第4期336-351,共16页Chinese Journal of Tuberculosis and Respiratory Diseases

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)的住院患者在临床救治过程中容易出现各种并发症,尤其是静脉血栓栓塞症(VTE),一旦发生,会导致患者的非预期死亡风险显著增加。近年来,国际已发布系列相关权威指南及高质量循证医学研究证据,工作组也于近期联合国内外VTE防治、重症救治、循证医学领域等多学科专家,共同制订了《新型冠状病毒感染住院患者血栓预防和抗凝管理指南》。基于此,工作组在指南的基础上对目前临床实践中亟需关注的13个临床问题进行了详细阐述,明确了标准化的操作路径,如:COVID-19住院患者的VTE风险和出血风险评估,不同严重程度的COVID-19住院患者以及合并妊娠、恶性肿瘤、基础疾病或脏器功能不全、服用抗病毒及抗炎药物、血小板减少等特殊人群的VTE预防和抗凝管理,COVID-19患者出院后的VTE预防及抗凝管理,COVID-19患者住院期间并发VTE的抗凝管理,正在进行VTE治疗且合并COVID-19患者的抗凝管理,COVID-19住院患者出血危险因素、临床分型及相应处理等。特别是参照了国际最新指南及研究证据,对于COVID-19住院患者如何准确把握标准预防剂量抗凝和治疗剂量抗凝也给出了明确的实施建议,期望能为医护人员针对COVID-19住院患者的血栓预防和抗凝管理提供标准化的操作流程和实施方案。Inpatients infected with SARS-CoV-2 are prone to various complications during clinical treatment,especially venous thromboembolism(VTE),which significantly increases the risk of unexpected death.In recent years,a series of authoritative guidelines and high-quality evidence-based medicine research evidence have been published internationally.This working group has recently formulated the Guidelines for Thrombosis Prevention and Anticoagulant Management of Hospitalized Patients with Novel Coronavirus Infection with multidisciplinary experts in the fields of VTE prevention,critical care and evidence-based medicine from international and domestic experts.Based on this,the working group elaborated on 13 clinical issues in urgent need of attention and solution in current clinical practice on the basis of the guidelines and defined standardized operational paths,including VTE risk and bleeding risk assessment in hospitalized patients with COVID-19,VTE prevention and anticoagulant management of hospitalized COVID-19 patients with different severity and special patient populations complicated with pregnancy,malignant tumors,underlying diseases or organ insufficiency,usage of antiviral and anti-inflammatory drugs or thrombocytopenia,in addition to VTE prevention and anticoagulant management of discharged COVID-19 patients,anticoagulant management of COVID-19 patients complicated with VTE during hospitalization,anticoagulant management in patients undergoing VTE therapy with COVID-19,risk factors of bleeding in hospitalized patients with COVID-19,clinical classification and corresponding management.In particular,by referring to the latest international guidelines and research evidence,this paper provides clear implementation recommendations on how to accurately determine the standard preventive dose anticoagulation and therapeutic dose anticoagulation for hospitalized patients with COVID-19.This paper is expected to provide standardized operational procedures and implementation norms for healthcare workers to managing throm

关 键 词：血栓栓塞 新型冠状病毒感染 预防 抗凝 临床路径 

分 类 号：R511[医药卫生—内科学]