新冠肺炎住院患者的血栓预防和抗凝治疗:临床途径与实践

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引用次数: 0

摘要

住院患者感染SARS-CoV-2后,在临床治疗过程中容易出现各种并发症,尤其是静脉血栓栓塞(VTE),显著增加了意外死亡的风险。近年来,国际上陆续发表了一系列权威指南和高质量的循证医学研究证据。该工作组近期联合国内外VTE预防、重症监护、循证医学等多学科专家,制定了《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,阐述了当前临床实践中急需关注和解决的13个临床问题,并定义了标准化的操作路径,包括COVID-19住院患者静脉血栓栓塞风险和出血风险评估、不同严重程度的COVID-19住院患者静脉血栓栓塞预防和抗凝治疗以及合并妊娠、恶性肿瘤的特殊患者人群、基础疾病或脏器功能不全、抗病毒、抗炎药物使用或血小板减少、出院患者静脉血栓栓塞预防及抗凝管理、合并静脉血栓栓塞患者住院期间抗凝管理、合并静脉血栓栓塞治疗患者的抗凝管理、住院患者出血危险因素、临床分型及相应管理。特别是在参考国际最新指南和研究证据的基础上,本文就如何准确确定新冠肺炎住院患者抗凝标准预防剂量和治疗剂量提出了明确的实施建议。希望能为医护人员在COVID-19住院患者的血栓预防和抗凝管理中提供标准化的操作流程和实施规范。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
[Thromboprophylaxis and management of anticoagulation in hospitalized patients with COVID-19: clinical pathway and practices].

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 thrombus prevention and anticoagulation in hospitalized patients with COVID-19.

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