ICU危重患者静脉血栓栓塞症预防策略

doi:10.16352/j.issn.1001-6325.2024.07.0906

基础医学与临床 ›› 2024, Vol. 44 ›› Issue (7): 906-911.doi: 10.16352/j.issn.1001-6325.2024.07.0906

• 特邀专题：静脉血栓栓塞症 • 上一篇下一篇

ICU危重患者静脉血栓栓塞症预防策略

谢芳菲¹, 李双玲^1*, 王春梅²

1.北京大学第一医院重症医学科,北京 100034;
2.首都医科大学宣武医院重症医学科,北京 100053

收稿日期:2024-04-22 修回日期:2024-05-20 出版日期:2024-07-05 发布日期:2024-06-26
通讯作者: ^*lishuangling888@hotmail.com
基金资助:
国家临床重点专科建设项目(2023-141);首都卫生发展科研专项(首发2022-2-2016)

Prevention strategies of venous thromboembolism in critically ill ICU patients

XIE Fangfei¹, LI Shuangling^1*, WANG Chunmei²

1. Department of Critical Care Medicine, Peking University First Hospital, Beijing 100034;
2. Department of Critical Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, China

Received:2024-04-22 Revised:2024-05-20 Online:2024-07-05 Published:2024-06-26
Contact: ^*lishuangling888@hotmail.com

摘要/Abstract

摘要： 静脉血栓栓塞症(VTE)包括深静脉血栓形成(DVT)和肺栓塞(PE)。重症监护病房(ICU)患者常合并诸多诱发VTE的危险因素,是发生VTE的高危人群。危重患者的VTE预防策略至关重要,包括识别危险因素、血栓与出血风险评估、机械预防和药物预防、效果监测、质量控制等措施。ICU患者VTE发生风险高,其出血风险亦不容忽视,综合评估危重患者血栓与出血风险并给予及时有效的预防和监测措施,是ICU医师所面临的焦点问题。本文对危重患者VTE预防策略相关研究进展进行综述,旨在为危重患者的VTE预防管理提供临床依据。

关键词: 静脉血栓栓塞症, 危重患者, 风险评估, 血栓预防策略

Abstract: Venous thromboembolism (VTE) includes deep venous thrombosis (DVT) and pulmonary embolism (PE). Patients in intensive care unit (ICU) are often at a high risk of VTE due to combining many risk factors. Prevention strategies of VTE in critically ill patients are crucial, including identification of risk factors, the risk assessment of thrombosis and bleeding, mechanical prophylaxis and drug prophylaxis, effect monitoring, and quality control. Since the risk of VTE in ICU patients is high, the risk of bleeding should not be ignored. It is a challenge for ICU physicians to comprehensively evaluate the risk of thrombosis and bleeding in critically ill patients and implement effective preventive and monitoring measures in time. This article reviews the relevant research progress on prevention strategies of VTE in critically ill patients in order to provide clinical evidence for the prophylaxis of VTE in critically ill patients.

Key words: venous thromboembolism, critically ill patients, risk assessment, thromboprophylaxis strategy

中图分类号:

R543.6

谢芳菲, 李双玲, 王春梅. ICU危重患者静脉血栓栓塞症预防策略[J]. 基础医学与临床, 2024, 44(7): 906-911.

XIE Fangfei, LI Shuangling, WANG Chunmei. Prevention strategies of venous thromboembolism in critically ill ICU patients[J]. Basic & Clinical Medicine, 2024, 44(7): 906-911.

参考文献

[1]内科住院患者静脉血栓栓塞症预防中国专家建议写作组,中华医学会呼吸病学分会,中华医学会老年医学分会,等. 内科住院患者静脉血栓栓塞症预防中国专家建议(2015)[J]. 中华结核和呼吸杂志,2015,38:484-491.
[2]Minet C, Potton L, Bonadona A, et al. Venous thromboembolism in the ICU: main characteristics, diagnosis and thromboprophylaxis[J]. Crit Care, 2015,19:287. doi:10.1186/s13054-015-1003-9.
[3]Malato A, Dentali F, Siragusa S, et al. The impact of deep vein thrombosis in critically ill patients: a Meta-analysis of major clinical outcomes[J]. Blood Transfus, 2015,13:559-568.
[4]中国健康促进基金会血栓与血管专项基金专家委员会,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. 医院内静脉血栓栓塞症防治与管理建议[J]. 中华医学杂志,2018,98:1383-1388.
[5]Tran A, Fernando SM, Rochwerg B, et al. Prognostic factors associated with development of venous thromboembolism in critically e patients-a systematic review and Meta-analysis[J]. Crit Care Med, 2022,50:e370-e381.
[6]National Institute for Health and Care Excellence (NICE). Venous thromboembolic diseases: diagnosis, management and thrombophilia testing[EB/OL]. (2023-08-02) [2024-01-15].https://www.nice.org.uk/guidance/ng158.
[7]Chen X, Huang J, Liu J, et al. Venous thromboembolism risk factors and prophylaxis of elderly intensive care unit patients in a Chinese general hospital[J]. Ann Palliat Med, 2021,10:4453-4462.
[8]Villiger R, Julliard P, Darbellay Farhoumand P, et al. Prediction of in-hospital bleeding in acutely ill medical patients: External validation of the IMPROVE bleeding risk score[J]. Thromb Res, 2023,230:37-44.
[9]中国健康促进基金会血栓与血管专项基金专家委员会. 静脉血栓栓塞症机械预防中国专家共识[J]. 中华医学杂志,2020,100:484-492.
[10]Liew NC, Alemany GV, Angchaisuksiri P, et al. Asian venous thromboembolism guidelines: updated recommendations for the prevention of venous thromboembolism[J]. Int Angiol, 2017,36:1-20.
[11]Herring B, Lowen D, Ho P, et al. A systematic review of venous thromboembolism mechanical prophylaxis devices during surgery[J]. Langenbecks Arch Surg, 2023,408:410. doi:10.1007/s00423-023-03142-6.
[12]Schünemann HJ, Cushman M, Burnett AE, et al. American Society of Hematology 2018 guidelines for manage-ment of venous thromboembolism: prophylaxis for hospitalized and nonhospitalized medical patients[J]. Blood Adv, 2018,2:3198-3225.
[13]Fernando SM, Tran A, Cheng W, et al. VTE prophylaxis in critically Ⅲ adults: a systematic review and network Meta-analysis[J]. Chest, 2022,161:418-428.
[14]DeBiase C, Giuliano CA, Doshi M, et al. Enoxaparin versus unfractionated heparin for venous thromboembolism prophylaxis in renally impaired ICU patients[J]. Pharmacotherapy, 2021,41:424-429.
[15]MacDougall K, Spyropoulos AC. New paradigms of extended thromboprophylaxis in medically Ill patients[J]. J Clin Med, 2020,9:1002. doi:10.3390/jcm9041002.
[16]Helms J, Tacquard C, Severac F, et al. High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study[J]. Intensive Care Med, 2020,46:1089-1098.
[17]Haykal T, Zayed Y, Dhillon H, et al. Meta-analysis of the role of intermittent pneumatic compression of the lower limbs to prevent venous thromboembolism in critically Ill patients[J]. Int J Low Extrem Wounds, 2022,21:31-40.
[18]Wang CM, Guo XF, Liu LM, et al. Prevention of deep vein thrombosis by panax notoginseng saponins combined with low-molecular-weight heparin in surgical patients[J]. Chin J Integr Med, 2022,28:771-778.
[19]Eck RJ, Hulshof L, Wiersema R, et al. Incidence, prognostic factors, and outcomes of venous thromboembolism in critically ill patients: data from two prospective cohort studies[J]. Crit Care, 2021,25:27. doi:10.1186/s13054-021-03457-0.
[20]Pannucci CJ, Fleming KI, Bertolaccini CB, et al. Assessment of anti-factor Xa levels of patients undergoing colorectal surgery given once-daily enoxaparin prophylaxis: a clinical study examining enoxaparin pharmacokinetics[J]. JAMA Surg, 2019,154:697-704.
[21]Dutt T, Simcox D, Downey C, et al. Thromboprophylaxis in COVID-19: anti-FXa-the missing factor?[J]. Am J Respir Crit Care Med, 2020,202:455-457.
[22]Rappold JF, Sheppard FR, Carmichael Ii SP, et al. Venous thromboembolism prophylaxis in the trauma intensive care unit: an American Association for the Surgery of Trauma Critical Care Committee Clinical Consensus Document[J]. Trauma Surg Acute Care Open, 2021,6:e000643. doi:10.1136/tsaco-2020-000643.
[23]Wu T, Xia X, Chen W, et al. The effect of anti-Xa monitoring on the safety and efficacy of low-molecular-weight heparin anticoagulation therapy: a systematic review and Meta-analysis[J]. J Clin Pharm Ther, 2020,45:602-608.
[24]Tran A, Fernando SM, Gates RS, et al. Efficacy and safety of anti-Xa-guided versus fixed dosing of low molecular weight heparin for prevention of venous thromboembolism in trauma patients: a systematic review and meta-analysis[J]. Ann Surg, 2023,277:734-741.
[25]Karcutskie CA, Dharmaraja A, Patel J, et al. Association of anti-factor Xa-guided dosing of enoxaparin with venous thromboembolism after trauma[J]. JAMA Surg, 2018,153:144-149.
[26]Saunders JA, Vazquez SR, Hill JA, et al. Clinical outcomes associated with anti-Xa-monitored enoxaparin for venous thromboembolism prophylaxis[J]. Pharmacotherapy, 2024,44:224-230.
[27]Wang C, Ning YC, Song LP, et al. Anti-factor Xa level monitoring of low-molecular-weight heparin for prevention of venous thromboembolism in critically ill patients (AXaLPE): protocol of a randomised, open-label controlled clinical trial[J]. BMJ Open, 2023,13:e069742. doi:10.1136/bmjopen-2022-069742.
[28]Sahle BW, Pilcher D, Peter K, et al. Trends and risk factors for omission of early thromboprophylaxis in Australian and New Zealand ICUs between 2009 and 2020[J]. Intensive Care Med, 2022,48:590-598.
[29]Helms J, Middeldorp S, Spyropoulos AC. Thromboprophylaxis in critical care[J]. Intensive Care Med, 2023,49:75-78.
[30]中国老年医学学会重症医学分会,浙江省重症医学临床医学研究中心. 老年重症患者静脉血栓栓塞症预防中国专家共识(2023)[J]. 中华危重病急救医学,2023,35:561-572.

ICU危重患者静脉血栓栓塞症预防策略

Prevention strategies of venous thromboembolism in critically ill ICU patients

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