老年重症患者静脉血栓栓塞症预防中国专家共识（2023）
静脉血栓栓塞症（venous thromboembolism，VTE）包括深静脉血栓形成（deep venous thrombosis，DVT）和肺血栓栓塞症（pulmonary thromboembolism，PTE）。重症监护病房（ICU）患者常处于卧床制动状态，伴有多病共存、感染，需要镇静、中心静脉置管、机械通气等，VTE风险更高[1,2]。据报道，ICU内DVT发生率为9.75%~31.00%[3]，若卧床时间超过10 d，发生率高达60%[4]。患者年龄越大，VTE发生率越高[5]，大于65岁的老年患者VTE发生率占全部VTE的60%以上[6]。尽管VTE预后差，但VTE是可以预防的[7,8]。目前，国内外虽然已有多个关于VTE预防的共识或指南，但尚缺少针对老年重症患者VTE预防的共识或指南，我国ICU内VTE预防情况并不乐观[9]。国家卫生健康委的数据显示，2018年VTE预防率仅为63.6%，2020年提高至76.5%，但与欧洲国家94%的VTE预防率相比，我国ICU内VTE预防仍存在很大提升空间。为进一步规范我国老年重症患者的VTE预防，特制定了《老年重症患者静脉血栓栓塞症预防中国专家共识（2023）》。本共识适用于65岁以上的老年重症患者。
本共识由中国老年医学学会重症医学分会和浙江省重症医学临床医学研究中心牵头，工作组成员查阅国内外相关指南，综合循证医学依据和临床经验，形成共识初稿，经全国19家医院20位重症医学和老年医学专家多次讨论，并以电子问卷形式发给专家小组，专家根据共识条目的理论依据、科学性、可行性等综合评分，确定各条目的推荐强度，最终形成共识。综合评分以1~10分计分，其中1~4分为不推荐，5~7分为弱推荐，8~10分为推荐。
1 老年重症患者的VTE风险评估和筛查
1.1 推荐意见1：
推荐Caprini评分表用于老年重症患者的VTE风险评估。〔推荐强度：推荐，（8.53±0.90）分〕
住院患者均需要VTE风险评估。指南推荐不同患者人群使用不同的风险评估量表[10]。目前仍缺乏ICU患者专用评估表，更没有针对老年重症患者的风险评分表，临床上常采用Caprini或Padua评分表[11,12]。根据简化的Caprini评分表，累加各项风险因素得分并计算总得分，将VTE风险分为低危（1~2分）、中危（3~4分）和高危（≥5分）。有研究显示，Caprini评分高危是ICU老年患者发生DVT的独立危险因素之一[13]。另一项关于ICU老年患者VTE危险因素的回顾性研究的亚组分析显示，Caprini风险评估模型对VTE的预测能力优于Padua评分（敏感度：0.687比0.350，P<0.000 1）[14]。与Padua评分相比，Caprini风险评估模型具有较高的敏感度，可识别出更多内外科VTE高风险患者[15]。因此，Caprini评分用于老年重症患者VTE风险评估是有效的。但Caprini评分表中缺乏多个ICU患者发生VTE的高危因素，如约束、昏迷、血小板输注、血管活性药物应用[16]、镇痛镇静治疗等[13]。此外，Caprini评分表中多个实验室指标（如抗心磷脂抗体、狼疮样抗凝物、Ⅴ因子等）在ICU期间通常不做常规检测，导致"不评估"或"默认否定"，降低了Caprini评分的准确性，因此可能低估ICU患者合并深静脉血栓的风险。新近研究报道了新的预测模型，如数学模型和机器学习等对ICU患者发生VTE的预测价值[17,18,19]，但是模型仍待完善。目前推荐Caprini评分表用于老年重症患者VTE危险分层的评估。
1.2 推荐意见2：
推荐老年重症患者入院或转科24 h内、术后、病情发生变化时、出院前进行VTE风险评估。〔推荐强度：推荐，（8.68±0.95）分〕
在澳大利亚和新西兰开展的一项包含175 665例成人ICU患者的研究表明，与早期接受VTE预防相比，入ICU 24 h内未接受VTE预防患者ICU病死率和住院病死率显著增加（7.6%比6.3%，P＝0.001；11.2%比10.6%，P＝0.003）[20]。因此，推荐在入ICU 24 h内进行VTE风险评估，以便在24 h内对老年重症患者实施VTE预防。手术（尤其急诊手术）是增加重症患者VTE发生风险的危险因素之一[2]，DVT最常发生在手术后24 h内[21]，因此术后需尽快进行VTE风险评估及出血风险评估，并进行相应预防。患者病情发生变化时〔如血压<90/60 mmHg或下降大于30%；动脉血氧分压（PaO2）<60 mmHg或需要进行有创手术或紧急手术〕，VTE危险因素也随之改变，而转科患者大多存在病情改变，因此需再次评估。出院患者可能持续存在VTE相关的危险因素，故出院前仍需再次评估。因此，推荐对所有ICU患者（包括老年重症患者）在入院或转科24 h内、手术后、病情发生变化时、出院前5个时间点均需要进行VTE风险评估。
老年重症患者的VTE症状和体征往往是非特异性的，尤其昏迷、气管插管、镇痛镇静等进一步增加了VTE的诊断难度，有临床症状、疑诊患者应进行VTE筛查。根据Wells评分将DVT临床可能性分为低度可能（0~1分）和高度可能（≥2分）。评估为低度可能的老年重症患者，若D-二聚体检测阴性，可初步排除DVT。对于疑诊PTE的老年重症患者，需要基于临床经验或应用临床可能性评分（常用简化Wells评分、修订版Geneva评分量表等）进行PTE临床可能性评估。临床评估低度可能的患者，若D-二聚体检测阴性，可基本排除急性PTE。
1.3 推荐意见3：
评估D-二聚体检测结果的诊断价值时应考虑年龄因素的影响。推荐对老年重症患者D-二聚体的正常阈值进行年龄修正。〔推荐强度：推荐，（8.42±1.17）分〕
D-二聚体是交联纤维蛋白在纤溶系统作用下产生的可溶性降解产物，为特异性继发性纤溶标志物。当血栓形成时，血栓纤维蛋白溶解，D-二聚体水平升高。D-二聚体对急性PTE的诊断敏感度为92%~100%，对低度临床可能性患者具有较高的阴性预测价值。但D-二聚体水平受多种因素的影响，炎症、恶性肿瘤、弥散性血管内凝血、肝或肾功能不全、出血、创伤、手术和坏死、妊娠、年龄等均可引起血浆D-二聚体水平升高。因此，D-二聚体升高对诊断PTE的阳性预测价值较低，不能用于确诊。
D-二聚体水平随年龄的增长而升高，老年患者D-二聚体水平往往高于常规临界值（500 μg/L）[22]。年龄校正后D-二聚体截断值（age adjusted D-dimer，AADD）＝年龄×10 μg/L，年龄>50岁，可以在保持VTE诊断敏感度的同时提高特异度，避免不必要的经济负担和检查[23,24,25]。荟萃分析表明，对于50岁以上患者人群（包括门诊、住院和急诊），AADD诊断VTE的价值优于D-二聚体标准值（敏感度>97%，特异度在各年龄层增加了4.7%~20.5%）[26]。因此，在评估D-二聚体检测结果的诊断价值时应考虑年龄因素的影响。推荐对老年重症患者D-二聚体的正常阈值进行年龄修正。
1.4 推荐意见4：
推荐老年重症患者至少每周1次超声常规监测DVT。〔推荐强度：推荐，（8.21±1.08）分〕
老年重症患者常常需要更长的ICU住院时间，VTE高危状态维持时间较长，需要超声常规检查是否存在DVT。早期研究表明，超声常规监测DVT不减少症状性VTE事件，甚至会增加医疗负担[27,28]。随着近年对重症超声研究的增加，研究结果更支持定期DVT超声监测能够改善患者预后。2016年，一项针对ICU内VTE高危创伤患者的随机对照试验（RCT）研究显示，与非规律监测组相比，每周1次超声监测能更早发现DVT，降低PTE发生率（1.9%比7.0%，P＝0.014）[29]。2020年，充气加压预防静脉血栓栓塞症（pneumatic compression for preventing venous thromboembolism，PREVENT）研究亚组分析了2 065例内外科重症患者（平均年龄59岁），发现每周2次超声监测能够早期诊断DVT（d：4比20）和PTE（d：4.0比7.5），从而降低PTE发生率（1.0%比1.6%）和90 d全因病死率〔调整后的风险比（hazard ratio，HR）＝0.75，95%可信区间（95% confidence interval，95%CI）为0.57~0.98〕[30]。因此，推荐对老年重症患者超声常规监测DVT，至少每周1次。
重症医师在床旁进行下肢超声检查可以准确诊断下肢近端DVT，敏感度为85%，特异度为96%[31]。经过培训的重症医师的下肢静脉超声检查可靠又有效[32]。DVT床旁超声监测是由专科超声医生实施还是由经过重症超声培训的重症医师实施，每家医院可根据具体情况而定。
1.5 推荐意见5：
推荐采用标准的DVT超声检查流程。〔推荐强度：推荐，（8.89±1.05）分〕
③入ICU后48~72 h内行CUS检查1次，第1周后每周检查1次或2次（图1C）。标准化方法不仅可以优化ICU和住院期间的DVT随访，也可以优化出院后的DVT随访[16,35]。
⑤血管管壁增厚、管腔变细、侧支循环形成为慢性DVT征象。
⑦静脉瓣固定。
书籍广告
2 老年重症患者的VTE预防
老年重症患者的VTE预防包括一般预防、机械预防和药物预防。一般预防包括：控制血脂血糖、适量补液、抬高患肢、有创操作尽量轻柔、避免损伤血管内皮、早期康复、功能锻炼等。对于VTE风险低危的老年重症患者，应给予机械预防。对于VTE风险中危的老年重症患者，应给予机械或药物预防。对于VTE风险高危的老年重症患者，若出血风险低或没有明显的抗凝禁忌，应选择药物预防；若不能选择药物预防，应进行机械预防。
2.1 老年重症患者VTE的药物预防
2.1.1 推荐意见6：
推荐对所有需要药物预防的老年重症患者动态评估出血风险。〔推荐强度：推荐，（9.16±0.90）分〕
鉴于抗凝药物潜在的出血风险，推荐对所有需要抗凝药物治疗的老年重症患者进行出血风险评估。按照专科诊疗规范和患者的出血危险因素制定出血风险的专科评估表，确保实施规范的出血风险评估。但是，目前没有针对老年重症患者的专科出血风险评估表单。2011年，一项观察性研究纳入10 866例平均年龄68岁的内科住院患者，基于入院时预测院内出血的11个独立危险因素（消化道出血活动期、出血史、血小板计数低下、年龄、肝功能不全、肾功能不全、入ICU治疗、中心静脉置管、风湿性疾病、恶性肿瘤和男性），开发了国际VTE内科预防注册登记（international medical prevention registry on venous thromboembolism，IMPROVE）出血风险评分表。IMPROVE出血风险评分表对每一项危险因素赋予不同权重，50%以上的大出血事件发生在出血风险评分≥7分的内科住院患者中[37]。内科患者出血危险因素见表1。
外科类（手术、有创操作类）患者采用外科患者出血风险评估表评估[38]。心脏手术患者是出血高风险人群，心脏手术后出血的危险因素包括接受阿司匹林或氯吡格雷治疗、肾功能不全、较长的体外循环时间[39,40,41]。有学者对1 223例接受全肺切除术或扩大切除术的患者进行研究发现，约5%的患者因出血需要重新探查，因此，全肺切除术或扩大切除术是患者出血的危险因素[42]。有学者对纳入20项研究、超过31 000例开颅手术患者的资料进行分析发现，脑出血的基线风险为1.1%（95%CI为0.9%~1.4%）[43]。脊柱手术、脊柱外伤、游离皮瓣患者出血风险显著增加[44]。还有研究表明，腹部手术患者出血的危险因素包括术前血红蛋白<130 g/L、恶性肿瘤和定义为2次或更多手术、困难解剖或不止1次吻合的复杂手术[45]。胰十二指肠切除术的出血危险因素包括脓毒症、胰漏、手术部位出血[46]。肝切除术的出血危险因素为原发性肝癌、术前血红蛋白及血小板计数低[47]。此外，外科手术患者还存在与基础疾病相关的出血危险因素，如活动性出血等[47,48]。外科患者出血危险因素见表2。
老年重症患者的基础疾病较多，可能同时伴有肾功能不全、体重异常等情况，药物预防时往往存在更高的出血风险，需及时动态进行出血风险评估[49]。进行出血风险评估时，需要结合患者具体情况、干预因素等综合评价。但是，出血高危并不代表抗凝禁忌。需要考虑利弊后决定是否抗凝治疗，加强监测。如出现病情变化，VTE风险和出血风险会随之改变，需要再评估，并及时调整干预策略。
2.1.2 推荐意见7：
VTE高危的老年重症患者选择药物预防时，推荐使用低分子肝素（优于普通肝素）。〔推荐强度：推荐，（8.47±0.97）分〕
2.1.3 推荐意见8：
严重肾功能不全〔肾小球滤过率（GFR）<30 mL/min〕的老年重症患者，推荐普通肝素、达肝素用于高危VTE的药物预防。〔推荐强度：推荐，（8.16±0.83）分〕
2.1.4 推荐意见9：
对于体重显著异常的老年重症患者建议结合体重等因素综合评估，调整低分子肝素剂量。〔推荐强度：推荐，（8.58±0.90）分〕
2.1.5 推荐意见10：
对于口服用药的老年慢性重症患者，推荐新型口服抗凝剂（new oral anticoagulant，NOAC）。〔推荐强度：弱推荐，（7.95±0.85）分〕
2.1.6 推荐意见11：
两种抗凝药物需要序贯时，推荐参考药物代谢动力学进行调整。〔推荐强度：推荐，（8.53±0.84）分〕
2.1.7 推荐意见12：
不同抗凝药物使用时，推荐选择不同方法进行凝血功能监测。〔推荐强度：推荐，（8.47±1.02）分〕
2.2 老年重症患者VTE的机械预防
2.2.1 推荐意见13：
进行机械预防的老年重症患者，推荐首选间歇性充气加压装置（intermittent pneumatic compression device，IPCD）。〔推荐强度：推荐，（8.44±0.98）分〕
VTE机械预防设备包括IPCD、足底静脉泵（foot vein pump，VFP）、梯度压力弹力袜（graduated compression stockings，GCS）等。围手术期研究表明，使用IPCD或GCS均可降低DVT发生率[87]，但IPCD效果更优[88]。一项分层Meta分析纳入70项研究共16 164例住院患者，比较了IPCD预防与其他机械预防、药物预防组间VTE的发生率，结果显示IPCD可显著降低VTE的发生率（DVT：7.3%比16.7%，PTE：1.2%比2.8%）[89]。一项针对重症患者（平均年龄50.2岁）的研究表明，与没有机械性血栓预防相比，IPCD的使用与VTE发生率显著降低相关（倾向评分校正HR＝0.45，95%CI为0.22~0.95，P＝0.04），GCS与VTE发生率降低无关[90]。在上述研究中，IPCD使用时间均大于18 h，因此推荐IPCD用于VTE高危的ICU患者的机械预防，每日使用18 h以上。但是，对于老年重症患者需要结合其耐受性、具体情况等综合考虑。
③下肢局部情况异常、血管病变，下肢严重畸形等。机械预防期间，应注意保暖，密切观察患者下肢皮肤颜色及温度有无改变、足背动脉搏动是否正常，加压部位是否存在肿胀、麻木、疼痛等不适，并注意患者有无胸闷、呼吸困难、发绀等表现。
2.2.2 推荐意见14：
老年重症患者使用机械预防VTE时，IPCD推荐首选膝下型。〔推荐强度：推荐，（8.26±1.19）分〕
IPCD根据长度不同，可分为全腿型、膝下型、足底型。针对不同类型IPCD的选择，有限的研究主要集中在创伤及骨科围手术期患者。全腿型或膝下型IPCD预防创伤患者DVT的价值显著优于足底型IPCD（DVT发生率：6.5%比21.0%，P＝0.009）[91]，且能更有效地减少术后腿部肿胀（大腿周长增加率：1.22%比3.19%，P<0.01）[92]。全腿型IPCD与膝下型IPCD两组间DVT发生率〔相对危险度（relative risk，RR）＝0.69，95%CI为0.37~1.32〕、PE发生率（RR＝0.79，95%CI为0.12~5.10）差异有统计学意义，但病死率差异无统计学意义[93]。全腿型压力覆盖面积更大，但有效性及舒适性均不及膝下型加压套[94]。老年重症患者由于深静脉置管、下肢肌肉不足等因素，更适合膝下型。因此，推荐采用膝下型IPCD用于老年重症患者的VTE机械预防。
2.2.3 推荐意见15：
不推荐老年重症患者常规药物预防联合机械预防VTE。〔推荐强度：推荐，（8.16±0.90）分〕
2013年一项纳入70项研究、涉及16 164例住院患者的分层Meta分析显示，间歇性充气加压（intermittent pneumatic compression，IPC）联合药物预防VTE的效果优于单用IPC（RR＝0.54，95%CI为0.32~0.91，P＝0.02）[89]。2019年PREVENT多中心RCT研究纳入2 003例成人重症患者（平均年龄58岁），结果显示，与单用药物预防血栓相比，药物联合IPC并未降低DVT发生率（3.9%比4.2%，RR＝0.93，95%CI为0.60~1.44，P＝0.74），且PTE发生率（0.8%比1.0%，RR＝0.82）和90 d全因病死率（26.1%比26.7%，RR＝0.98）差异也均无统计学意义[95]。药物联合机械预防VTE的有效性因此受到质疑。2020年的Meta分析纳入包括PREVENT试验在内的8项RCT共7 354例住院患者（年龄58~75岁），结果显示，与单用药物预防相比，药物联合IPC的VTE预防获益仅见于手术患者（RR＝0.30，95%CI为0.15~0.59），而对于内科患者未见获益（RR＝0.80，95%CI为0.60~1.07）[96]。因此，不推荐VTE高危患者常规药物联合机械预防。也有专家提出，对于仅能使用较低剂量抗凝药物的老年重症患者，药物联合机械预防可能比单一低剂量药物或单一机械预防效果好，但是上述观点尚需进一步临床研究验证。
3 其他预防
3.1 推荐意见16：
推荐接受体外膜肺氧合（ECMO）支持的老年重症患者加强VTE筛查和风险评估。〔推荐强度：推荐，（8.21±1.13）分〕
接受ECMO支持的患者常常同时需要接受药物抗凝，但ECMO仍与较高的VTE发生率相关。有文献报道，静脉-静脉ECMO（veno-venous ECMO，VV-ECMO）相关的VTE发生率可高达18%，常见于颈内静脉和下腔静脉[97]。VTE不仅会发生在ECMO使用期间，而且在ECMO撤离后也会出现，甚至发生率高达60%[98]。因此，更需早期VTE筛查和评估。对于没有VTE证据的患者，应在ECMO撤离后开始药物预防[97]。
3.2 推荐意见17：
存在下肢深静脉血栓的老年重症患者，不推荐常规植入滤器预防肺栓塞。〔推荐强度：推荐，（8.95±0.78）分〕
一项纳入11项研究的Meta分析表明，对于存在肺栓塞风险的患者（年龄68.0~72.2岁）植入下腔静脉滤器尽管可降低肺栓塞风险（OR＝0.50，95%CI为0.33~0.75），但同时也增加了DVT风险（OR＝1.70，95%CI为1.17~2.48），而且全因病死率无明显变化（OR＝0.91，95%CI为0.70~1.19）[99]。同时，植入滤器本身存在一定风险及并发症（包括滤器移位、倾斜，下腔静脉穿孔、血栓形成等）。老年重症患者常常伴有不同程度的器官功能障碍，可进一步增加手术风险和术后并发症。因此，存在DVT的老年重症患者是否需要植入滤器需要谨慎评估，不推荐常规植入滤器预防肺栓塞。当DVT患者出现抗凝禁忌或抗凝治疗失败时，可以考虑血管外科会诊以评估是否植入下腔静脉滤器[100]。
4 下肢孤立性远端深静脉血栓（isolated distal deep venous thrombosis，IDDVT）
IDDVT是DVT中的一种，在ICU老年患者中并不少见。IDDVT指局限在腘静脉以下的小腿静脉血栓，可累及胫前静脉、胫后静脉、腓静脉和小腿肌间静脉（比目鱼肌静脉、腓肠肌静脉）等远端深静脉血栓，但是没有进展为近端深静脉血栓和肺栓塞。IDDVT存在向近心端蔓延和发展为肺栓塞的风险，受到越来越多临床医生的关注。2周以内的急性IDDVT与急性期近端DVT的抗凝治疗一致，陈旧性IDDVT是VTE预防的重点[100,101]。
4.1 推荐意见18：
合并陈旧性下肢IDDVT的患者推荐药物预防。〔推荐强度：推荐，（8.50±0.86）分〕
与急性IDDVT相比，陈旧性IDDVT存在静脉血栓病史，在Caprini评分量表中分值为3分。ICU内老年陈旧性IDDVT患者Caprini评分≥5分（年龄至少可获得2~3分），属于VTE高危患者。推荐老年重症患者结合体重、肾功能等进行VTE药物预防。
5 中心静脉导管相关性血栓
ICU患者常常需要留置中心静脉导管，中心静脉导管留置是ICU患者发生VTE的危险因素之一。中心静脉导管相关性血栓是ICU内DVT的一种特殊且常见类型，文献报道其发生率为2%~67%[102]。
5.1 推荐意见19：
不推荐对留置中心静脉导管的老年重症患者常规进行预防性抗凝。〔推荐强度：推荐，（8.11±1.05）分〕
早期小样本研究表明，小剂量华法林（1 mg每日1次）或低分子肝素（2 500 U达肝素每日1次）可以降低癌症患者导管相关性血栓的发生率（9.5%比39.75%，P<0.001；6%比62%，P＝0.002）[103]。但是，该结果未能在后期更大样本的前瞻性RCT研究中得到证实。Verso等[104]的多中心随机双盲研究连续纳入了321例留置深静脉的肿瘤患者（平均年龄59岁），并随机分为抗凝组（依诺肝素40 mg每日1次）及安慰剂组，发现抗凝组与安慰剂组6周内导管相关性血栓发生率差异并无统计学意义（14.1%比18.0%，P＝0.35）。另一项研究纳入439例肿瘤患者（平均年龄56岁），被分为抗凝组（达肝素5 000 U每日1次）及安慰剂组，结果显示达肝素预防性抗凝12周并不能降低中心静脉留置后血栓栓塞并发症（7.1%比7.6%，P>0.05）[105]。因此，不建议对留置中心静脉导管的患者常规进行预防性抗凝。
5.2 推荐意见20：
明确诊断为导管相关性血栓的患者不推荐常规拔除导管；有必要拔除导管患者，可充分评估相关风险后拔除，拔除导管前应充分抗凝。〔推荐强度：推荐，（8.05±0.78）分〕
对于导管相关性血栓患者不推荐常规拔除导管[106,107]。如果患者仍然需要中心静脉导管，可在抗凝治疗下继续保留并正常用于临床治疗。中心静脉导管相关症状性DVT研究主要集中在癌症患者，Davies等[108]随访了接受12周利伐沙班抗凝治疗的74例癌症患者，没有一例患者因血栓形成而拔除导管。对于中心静脉导管相关性血栓患者，如无抗凝禁忌证，推荐保留导管期间持续抗凝治疗。拔除导管前持续抗凝时间需充分考虑血栓位置、大小及拔除导管后发生栓塞和其他并发症的风险等，对于开始抗凝治疗后取出导管的最佳时间目前尚无临床证据支持，故暂不予推荐。拔除导管后建议持续抗凝3个月[109]。存在以下情况时可以考虑拔除导管：治疗已不需要该导管；导管功能丧失；导管位置异常；合并导管相关性血流感染。但是，以上推荐均基于深静脉血栓治疗临床经验，缺乏高质量的临床证据支持。
6 老年重症患者VTE的预防流程
6.1 推荐意见21：
为了规范老年重症患者的VTE预防，推荐实施VTE流程化管理。〔推荐强度：推荐，（9.21±0.79）分〕
参考文献(上下滑动可查阅更多内容)
[1]
KaplanD, CasperTC, ElliottCG, et al. VTE incidence and risk factors in patients with severe sepsis and septic shock [J]. Chest, 2015, 148 (5): 1224-1230. DOI: 10.1378/chest.15-0287.
[2]
LiL, ZhouJ, HuangLQ, et al. Prevention, treatment, and risk factors of deep vein thrombosis in critically ill patients in Zhejiang Province, China: a multicenter, prospective, observational study [J]. Ann Med, 2021, 53 (1): 2234-2245. DOI: 10.1080/07853890.2021.2005822.
[3]
MinetC, PottonL, BonadonaA, et al. Venous thromboembolism in the ICU: main characteristics, diagnosis and thromboprophylaxis [J]. Crit Care, 2015, 19 (1): 287. DOI: 10.1186/s13054-015-1003-9.
[4]
BoonyawatK, CrowtherMA. Venous thromboembolism prophylaxis in critically ill patients [J]. Semin Thromb Hemost, 2015, 41 (1): 68-74. DOI: 10.1055/s-0034-1398386.
[5]
SpencerFA, GurwitzJH, SchulmanS, et al. Venous thromboembolism in older adults: a community-based study [J]. Am J Med, 2014, 127 (6): 530-537.e3. DOI: 10.1016/j.amjmed.2014.02.011.
[6]
TritschlerT, AujeskyD. Venous thromboembolism in the elderly: a narrative review [J]. Thromb Res, 2017, 155: 140-147. DOI: 10.1016/j.thromres.2017.05.015.
[7]
ISTH Steering Committee for World Thrombosis Day. Thrombosis: a major contributor to global disease burden [J]. Thromb Res, 2014, 134 (5): 931-938. DOI: 10.1016/j.thromres.2014.08.014.
[8]
CascianoJP, DotiwalaZ, KempR, et al. Economic burden of recurrent venous thromboembolism: analysis from a U.S. hospital perspective [J]. Am J Health Syst Pharm, 2015, 72 (4): 291-300. DOI: 10.2146/ajhp140204.
[9]
YanJ, ZhouJ, ZhenJH, et al. Knowledge and awareness of venous thromboembolism in intensive care units in Zhejiang Province, China: a cross-sectional survey [J]. Med Sci Monit, 2020, 26: e923378. DOI: 10.12659/MSM.923378.
[10]
DarziAJ, ReppAB, SpencerFA, et al. Risk-assessment models for VTE and bleeding in hospitalized medical patients: an overview of systematic reviews [J]. Blood Adv, 2020, 4 (19): 4929-4944. DOI: 10.1182/bloodadvances.2020002482.
[11]
KahnSR, LimW, DunnAS, et al. Prevention of VTE in nonsurgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines [J]. Chest, 2012, 141 (2Suppl): e195S-e226S. DOI: 10.1378/chest.11-2296.
[12]
ObiAT, PannucciCJ, NackashiA, et al. Validation of the Caprini venous thromboembolism risk assessment model in critically ill surgical patients [J]. JAMA Surg, 2015, 150 (10): 941-948. DOI: 10.1001/jamasurg.2015.1841.
[13]
LiL, ZhenJH, HuangLQ, et al. The risk factors for deep venous thrombosis in critically ill older adult patients: a subgroup analysis of a prospective, multicenter, observational study [J]. BMC Geriatr, 2022, 22 (1): 977. DOI: 10.1186/s12877-022-03599-y.
[14]
ChenXL, HuangJL, LiuJX, 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 (4): 4453-4462. DOI: 10.21037/apm-21-464.
[15]
ChenXL, PanL, DengH, et al. Risk assessment in Chinese hospitalized patients comparing the Padua and Caprini scoring algorithms [J]. Clin Appl Thromb Hemost, 2018, 24 (9_suppl): 127S-135S. DOI: 10.1177/1076029618797465.
[16]
CookD, CrowtherM, MeadeM, et al. Deep venous thrombosis in medical-surgical critically ill patients: prevalence, incidence, and risk factors [J]. Crit Care Med, 2005, 33 (7): 1565-1571. DOI: 10.1097/01.ccm.0000171207.95319.b2.
[17]
ViarasilpaT, PanyavachirapornN, MarashiSM, et al. Prediction of symptomatic venous thromboembolism in critically ill patients: the ICU-venous thromboembolism score [J]. Crit Care Med, 2020, 48 (6): e470-e479. DOI: 10.1097/CCM.0000000000004306.
[18]
MeiRQ, WangGD, ChenRX, et al. The ICU-venous thromboembolism score and tumor grade can predict inhospital venous thromboembolism occurrence in critical patients with tumors [J]. World J Surg Oncol, 2022, 20 (1): 245. DOI: 10.1186/s12957-022-02705-z.
[19]
RyanL, MatarasoS, SiefkasA, et al. A machine learning approach to predict deep venous thrombosis among hospitalized patients [J]. Clin Appl Thromb Hemost, 2021, 27: 1076029621991185. DOI: 10.1177/1076029621991185.
[20]
HoKM, ChavanS, PilcherD. Omission of early thromboprophylaxis and mortality in critically ill patients: a multicenter registry study [J]. Chest, 2011, 140 (6): 1436-1446. DOI: 10.1378/chest.11-1444.
[21]
中华医学会骨科学分会.中国骨科大手术静脉血栓栓塞症预防指南[J/CD].中华关节外科杂志（电子版）, 2009, 3 (3): 380-383. DOI: 10.3969/j.issn.1674-134X.2009.03.022.
[22]
HaaseC, JoergensenM, EllervikC, et al. Age- and sex-dependent reference intervals for D-dimer: evidence for a marked increase by age [J]. Thromb Res, 2013, 132 (6): 676-680. DOI: 10.1016/j.thromres.2013.09.033.
[23]
De PooterN, Brionne-FrançoisM, SmahiM, et al. Age-adjusted D-dimer cut-off levels to rule out venous thromboembolism in patients with non-high pre-test probability: clinical performance and cost-effectiveness analysis [J]. J Thromb Haemost, 2021, 19 (5): 1271-1282. DOI: 10.1111/jth.15278.
[24]
RighiniM, Van EsJ, Den ExterPL, et al. Age-adjusted D-dimer cut off levels to rule out pulmonary embolism: the ADJUST-PE study [J]. JAMA, 2014, 311 (11): 1117-1124. DOI: 10.1001/jama.2014.2135.
[25]
JaconelliT, EragatM, CraneS. Can an age-adjusted D-dimer level be adopted in managing venous thromboembolism in the emergency department? A retrospective cohort study [J]. Eur J Emerg Med, 2018, 25 (4): 288-294. DOI: 10.1097/MEJ.0000000000000448.
[26]
SchoutenHJ, GeersingGJ, KoekHL, et al. Diagnostic accuracy of conventional or age adjusted D-dimer cut-off values in older patients with suspected venous thromboembolism: systematic review and meta-analysis [J]. BMJ, 2013, 346: f2492. DOI: 10.1136/bmj.f2492.
[27]
RobinsonKS, AndersonDR, GrossM, et al. Ultrasonographic screening before hospital discharge for deep venous thrombosis after arthroplasty: the post-arthroplasty screening study. A randomized, controlled trial [J]. Ann Intern Med, 1997, 127 (6): 439-445. DOI: 10.7326/0003-4819-127-6-199709150-00004.
[28]
FurlanJC, FehlingsMG. Role of screening tests for deep venous thrombosis in asymptomatic adults with acute spinal cord injury: an evidence-based analysis [J]. Spine (Phila Pa 1976), 2007, 32 (17): 1908-1916. DOI: 10.1097/BRS.0b013e31811ec26a.
[29]
AllenCJ, MurrayCR, MeizosoJP, et al. Surveillance and early management of deep vein thrombosis decreases rate of pulmonary embolism in high-risk trauma patients [J]. J Am Coll Surg, 2016, 222 (1): 65-72. DOI: 10.1016/j.jamcollsurg.2015.10.014.
[30]
ArabiYM, BurnsK, AlsolamySJ, et al. Surveillance or no surveillance ultrasonography for deep vein thrombosis and outcomes of critically ill patients: a pre-planned sub-study of the PREVENT trial [J]. Intensive Care Med, 2020, 46 (4): 737-746. DOI: 10.1007/s00134-019-05899-1.
[31]
KoryPD, PellecchiaCM, ShilohAL, et al. Accuracy of ultrasonography performed by critical care physicians for the diagnosis of DVT [J]. Chest, 2011, 139 (3): 538-542. DOI: 10.1378/chest.10-1479.
[32]
RobertsL, RozenT, MurphyD, et al. A preliminary study of intensivist-performed DVT ultrasound screening in trauma ICU patients (APSIT Study) [J]. Ann Intensive Care, 2020, 10 (1): 122. DOI: 10.1186/s13613-020-00739-8.
[33]
HamperUM, DeJongMR, ScouttLM. Ultrasound evaluation of the lower extremity veins [J]. Radiol Clin North Am, 2007, 45 (3): 525-547, ix. DOI: 10.1016/j.rcl.2007.04.013.
[34]
BoddiM, PerisA. Deep vein thrombosis in intensive care [J]. Adv Exp Med Biol, 2017, 906: 167-181. DOI: 10.1007/5584_2016_114.
[35]
BoddiM, BarbaniF, AbbateR, et al. Reduction in deep vein thrombosis incidence in intensive care after a clinician education program [J]. J Thromb Haemost, 2010, 8 (1): 121-128. DOI: 10.1111/j.1538-7836.2009.03664.x.
[36]
全国肺栓塞-深静脉血栓形成防治协作组，中华医学会呼吸病学分会肺栓塞与肺血管病学组.肺血栓栓塞症-深静脉血栓形成影像学检查操作规程（推荐方案）[J].中华结核和呼吸杂志, 2005, 28 (9): 580-589. DOI: 10.3760/j:issn:1001-0939.2005.09.003.
[37]
DecoususH, TapsonVF, BergmannJF, et al. Factors at admission associated with bleeding risk in medical patients: findings from the IMPROVE investigators [J]. Chest, 2011, 139 (1): 69-79. DOI: 10.1378/chest.09-3081.
[38]
中华医学会重症医学分会.重症监护病房患者深静脉血栓形成预防指南[J].中国危重病急救医学, 2009, 21 (9): 514-517.DOI: 10.3760/cma.j.issn.1003-0603.2009.09.002.
[39]
MorawskiW, SanakM, CisowskiM, et al. Prediction of the excessive perioperative bleeding in patients undergoing coronary artery bypass grafting: role of aspirin and platelet glycoprotein Ⅲa polymorphism [J]. J Thorac Cardiovasc Surg, 2005, 130 (3): 791-796. DOI: 10.1016/j.jtcvs.2005.02.041.
[40]
KangW, ThemanTE, ReedJF 3rd, et al. The effect of preoperative clopidogrel on bleeding after coronary artery bypass surgery [J]. J Surg Educ, 2007, 64 (2): 88-92. DOI: 10.1016/j.jsurg.2006.10.003.
[41]
KarthikS, GraysonAD, McCarronEE, et al. Reexploration for bleeding after coronary artery bypass surgery: risk factors, outcomes, and the effect of time delay [J]. Ann Thorac Surg, 2004, 78 (2): 527-534; discussion 534. DOI: 10.1016/j.athoracsur.2004.02.088.
[42]
KiserAC. General aspects of surgical treatment [M]//DetterbeckFC. Diagnosis and treatment of lung cancer: an evidence-based guide for the practicing clinician. Philadelphia, PA: WB Saunders, 2001: 133-147.
[43]
DanishSF, BurnettMG, OngJG, et al. Prophylaxis for deep venous thrombosis in craniotomy patients: a decision analysis [J]. Neurosurgery, 2005, 56 (6): 1286-1292; discussion 1292-1294. DOI: 10.1227/01.neu.0000159882.11635.ea.
[44]
HemmilaMR, JakubusJL, MaggioPM, et al. Real money: complications and hospital costs in trauma patients [J]. Surgery, 2008, 144 (2): 307-316. DOI: 10.1016/j.surg.2008.05.003.
[45]
RochaAT, de VasconcellosAG, da Luz NetoER, et al. Risk of venous thromboembolism and efficacy of thromboprophylaxis in hospitalized obese medical patients and in obese patients undergoing bariatric surgery [J]. Obes Surg, 2006, 16 (12): 1645-1655. DOI: 10.1381/096089206779319383.
[46]
SimaCS, JarnaginWR, FongYM, et al. Predicting the risk of perioperative transfusion for patients undergoing elective hepatectomy [J]. Ann Surg, 2009, 250 (6): 914-921. DOI: 10.1097/sla.0b013e3181b7fad3.
[47]
KakkarVV, CohenAT, EdmonsonRA, et al. Low molecular weight versus standard heparin for prevention of venous thromboembolism after major abdominal surgery [J]. Lancet, 1993, 341 (8840): 259-265. DOI: 10.1016/0140-6736(93)92614-y.
[48]
ReynoldsMW, ClarkJ, CreanS, et al. Risk of bleeding in surgical patients treated with topical bovine thrombin sealants: a review of the literature [J]. Patient Saf Surg, 2008, 2: 5. DOI: 10.1186/1754-9493-2-5.
[49]
TungEC, YuSY, ShahK, et al. Reassessment of venous thromboembolism and bleeding risk in medical patients receiving VTE prophylaxis [J]. J Eval Clin Pract, 2020, 26 (1): 18-25. DOI: 10.1111/jep.13213.
[50]
CadeJF. High risk of the critically ill for venous thromboembolism [J]. Crit Care Med, 1982, 10 (7): 448-450. DOI: 10.1097/00003246-198207000-00006.
[51]
FraisseF, HolzapfelL, CoulandJM, et al. Nadroparin in the prevention of deep vein thrombosis in acute decompensated COPD [J]. Am J Respir Crit Care Med, 2000, 161 (4Pt 1): 1109-1114. DOI: 10.1164/ajrccm.161.4.9807025.
[52]
GaitanidisA, BreenKA, ChristensenMA, et al. Low-molecular weight heparin is superior to unfractionated heparin for elderly trauma patients [J]. J Surg Res, 2021, 268: 432-439. DOI: 10.1016/j.jss.2021.06.074.
[53]
DeA, RoyP, GargVK, et al. Low-molecular-weight heparin and unfractionated heparin in prophylaxis against deep vein thrombosis in critically ill patients undergoing major surgery [J]. Blood Coagul Fibrinolysis, 2010, 21 (1): 57-61. DOI: 10.1097/MBC.0b013e3283333505.
[54]
ShenL, QiuL, LiuD, et al. The association of low molecular weight heparin use and in-hospital mortality among patients hospitalized with COVID-19 [J]. Cardiovasc Drugs Ther, 2022, 36 (1): 113-120. DOI: 10.1007/s10557-020-07133-3.
[55]
PROTECT Investigators for the Canadian Critical Care Trials Group and the Australian and New Zealand Intensive Care Society Clinical Trials Group. Dalteparin versus unfractionated heparin in critically ill patients [J]. N Engl J Med, 2011, 364 (14): 1305-1314. DOI: 10.1056/NEJMoa1014475.
[56]
FernandoSM, TranA, ChengW, et al. VTE prophylaxis in critically ill adults: a systematic review and network Meta-analysis [J]. Chest, 2022, 161 (2): 418-428. DOI: 10.1016/j.chest.2021.08.050.
[57]
SchünemannHJ, CushmanM, BurnettAE, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: prophylaxis for hospitalized and nonhospitalized medical patients [J]. Blood Adv, 2018, 2 (22): 3198-3225. DOI: 10.1182/bloodadvances.2018022954.
[58]
DuranteauJ, TacconeFS, VerhammeP, et al. European guidelines on perioperative venous thromboembolism prophylaxis: intensive care [J]. Eur J Anaesthesiol, 2018, 35 (2): 142-146. DOI: 10.1097/EJA.0000000000000707.
[59]
ParkD, SouthernW, CalvoM, et al. Treatment with dalteparin is associated with a lower risk of bleeding compared to treatment with unfractionated heparin in patients with renal insufficiency [J]. J Gen Intern Med, 2016, 31 (2): 182-187. DOI: 10.1007/s11606-015-3466-4.
[60]
PaiM, AdhikariNKJ, OstermannM, et al. Low-molecular-weight heparin venous thromboprophylaxis in critically ill patients with renal dysfunction: a subgroup analysis of the PROTECT trial [J]. PLoS One, 2018, 13 (6): e0198285. DOI: 10.1371/journal.pone.0198285.
[61]
SebaalyJ, CovertK. Enoxaparin dosing at extremes of weight: literature review and dosing recommendations [J]. Ann Pharmacother, 2018, 52 (9): 898-909. DOI: 10.1177/1060028018768449.
[62]
BickfordA, MajercikS, BledsoeJ, et al. Weight-based enoxaparin dosing for venous thromboembolism prophylaxis in the obese trauma patient [J]. Am J Surg, 2013, 206 (6): 847-851, discussion 851-852. DOI: 10.1016/j.amjsurg.2013.07.020.
[63]
WangTF, MilliganPE, WongCA, et al. Efficacy and safety of high-dose thromboprophylaxis in morbidly obese inpatients [J]. Thromb Haemost, 2014, 111 (1): 88-93. DOI: 10.1160/TH13-01-0042.
[64]
FreemanA, HornerT, PendletonRC, et al. Prospective comparison of three enoxaparin dosing regimens to achieve target anti-factor Ⅹa levels in hospitalized, medically ill patients with extreme obesity [J]. Am J Hematol, 2012, 87 (7): 740-743. DOI: 10.1002/ajh.23228.
[65]
MirandaS, Le Cam-DuchezV, BenichouJ, et al. Adjusted value of thromboprophylaxis in hospitalized obese patients: a comparative study of two regimens of enoxaparin: the ITOHENOX study [J]. Thromb Res, 2017, 155: 1-5. DOI: 10.1016/j.thromres.2017.04.011.
[66]
RojasL, AizmanA, ErnstD, et al. Anti-Ⅹa activity after enoxaparin prophylaxis in hospitalized patients weighing less than fifty-five kilograms [J]. Thromb Res, 2013, 132 (6): 761-764. DOI: 10.1016/j.thromres.2013.10.005.
[67]
EbeidA, ColeE, Stallwood-HallC. The efficacy of weight-based enoxaparin dosing for venous thromboembolism prophylaxis in trauma patients: a systematic review and meta-analysis [J]. J Trauma Acute Care Surg, 2022, 93 (2): e71-e79. DOI: 10.1097/TA.0000000000003707.
[68]
RobinsonS, ZincukA, LarsenUL, et al. A comparative study of varying doses of enoxaparin for thromboprophylaxis in critically ill patients: a double-blinded, randomised controlled trial [J]. Crit Care, 2013, 17 (2): R75. DOI: 10.1186/cc12684.
[69]
AcharyaP, UpadhyayL, QaviA, et al. The paradox prevails: outcomes are better in critically ill obese patients regardless of the comorbidity burden [J]. J Crit Care, 2019, 53: 25-31. DOI: 10.1016/j.jcrc.2019.05.004.
[70]
KellerK, EngelhardtM. Strength and muscle mass loss with aging process. Age and strength loss [J]. Muscles Ligaments Tendons J, 2013, 3 (4): 346-350. DOI: 10.11138/mltj/2013.3.4.346.
[71]
RosenthalMD, KamelAY, RosenthalCM, et al. Chronic critical illness: application of what we know [J]. Nutr Clin Pract, 2018, 33 (1): 39-45. DOI: 10.1002/ncp.10024.
[72]
SinglaDL, MorrillGB. Warfarin maintenance dosages in the very elderly [J]. Am J Health Syst Pharm, 2005, 62 (10): 1062-1066. DOI: 10.1093/ajhp/62.10.1062.
[73]
American Geriatrics Society Clinical Practice Committee. The use of oral anticoagulants (warfarin) in older people. American Geriatrics Society guideline [J]. J Am Geriatr Soc, 2002, 50 (8): 1439-1445; discussion 1446-1447. DOI: 10.1046/j.1532-5415.2002.50380.x.
[74]
SchulmanS, KearonC, KakkarAK, et al. Dabigatran versus warfarin in the treatment of acute venous thromboembolism [J]. N Engl J Med, 2009, 361 (24): 2342-2352. DOI: 10.1056/NEJMoa0906598.
[75]
SchulmanS, KakkarAK, GoldhaberSZ, et al. Treatment of acute venous thromboembolism with dabigatran or warfarin and pooled analysis [J]. Circulation, 2014, 129 (7): 764-772. DOI: 10.1161/CIRCULATIONAHA.113.004450.
[76]
EINSTEIN-PE Investigators. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism [J]. N Engl J Med, 2012, 366 (14): 1287-1297. DOI: 10.1056/NEJMoa1113572.
[77]
BauersachsR, BerkowitzSD, BrennerB, et al. Oral rivaroxaban for symptomatic venous thromboembolism [J]. N Engl J Med, 2010, 363 (26): 2499-2510. DOI: 10.1056/NEJMoa1007903.
[78]
AgnelliG, BullerHR, CohenA, et al. Oral apixaban for the treatment of acute venous thromboembolism [J]. N Engl J Med, 2013, 369 (9): 799-808. DOI: 10.1056/NEJMoa1302507.
[79]
Hokusai-VTE Investigators. Edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism [J]. N Engl J Med, 2013, 369 (15): 1406-1415. DOI: 10.1056/NEJMoa1306638.
[80]
KubitzaD, BeckaM, RothA, et al. The influence of age and gender on the pharmacokinetics and pharmacodynamics of rivaroxaban: an oral, direct factor Ⅹa inhibitor [J]. J Clin Pharmacol, 2013, 53 (3): 249-255. DOI: 10.1002/jcph.5.
[81]
KubitzaD, BeckaM, MueckW, et al. Effects of renal impairment on the pharmacokinetics, pharmacodynamics and safety of rivaroxaban, an oral, direct factor Ⅹa inhibitor [J]. Br J Clin Pharmacol, 2010, 70 (5): 703-712. DOI: 10.1111/j.1365-2125.2010.03753.x.
[82]
中华医学会外科学分会血管外科学组.深静脉血栓形成的诊断和治疗指南（第三版）[J].中华血管外科杂志, 2017, 2 (4): 201-208. DOI: 10.3760/cma.j.issn.2096-1863.2017.04.002.
[83]
中华医学会外科学分会.中国普通外科围手术期血栓预防与管理指南[J].中华外科杂志, 2016, 54 (5): 321-327. DOI: 10.3760/cma.j.issn.0529-5815.2016.05.001.
[84]
《老年人心房颤动诊治中国专家建议》写作组，中华医学会老年医学分会，中华老年医学杂志编辑委员会.老年人非瓣膜性心房颤动诊治中国专家建议（2016）[J].中华老年医学杂志, 2016, 35 (9): 915-928. DOI: 10.3760/cma.j.issn.0254-9026.2016.09.001.
[85]
HirshJ, WarkentinTE, ShaughnessySG, et al. Heparin and low-molecular-weight heparin: mechanisms of action, pharmacokinetics, dosing, monitoring, efficacy, and safety [J]. Chest, 2001, 119 (1Suppl): 64S-94S. DOI: 10.1378/chest.119.1_suppl.64s.
[86]
Alhenc-GelasM, Jestin-Le GuernicC, VitouxJF, et al. Adjusted versus fixed doses of the low-molecular-weight heparin fragmin in the treatment of deep vein thrombosis. Fragmin-Study Group [J]. Thromb Haemost, 1994, 71 (6): 698-702. DOI: 10.1055/s-0038-1642507.
[87]
SachdevaA, DaltonM, LeesT. Graduated compression stockings for prevention of deep vein thrombosis [J]. Cochrane Database Syst Rev, 2018, 11 (11): CD001484. DOI: 10.1002/14651858.CD001484.pub4.
[88]
MorrisRJ, WoodcockJP. Intermittent pneumatic compression or graduated compression stockings for deep vein thrombosis prophylaxis? A systematic review of direct clinical comparisons [J]. Ann Surg, 2010, 251 (3): 393-396. DOI: 10.1097/SLA.0b013e3181b5d61c.
[89]
HoKM, TanJA. Stratified meta-analysis of intermittent pneumatic compression of the lower limbs to prevent venous thromboembolism in hospitalized patients [J]. Circulation, 2013, 128 (9): 1003-1020. DOI: 10.1161/CIRCULATIONAHA.113.002690.
[90]
ArabiYM, KhedrM, DaraSI, et al. Use of intermittent pneumatic compression and not graduated compression stockings is associated with lower incident VTE in critically ill patients: a multiple propensity scores adjusted analysis [J]. Chest, 2013, 144 (1): 152-159. DOI: 10.1378/chest.12-2028.
[91]
ElliottCG, DudneyTM, EggerM, et al. Calf-thigh sequential pneumatic compression compared with plantar venous pneumatic compression to prevent deep-vein thrombosis after non-lower extremity trauma [J]. J Trauma, 1999, 47 (1): 25-32. DOI: 10.1097/00005373-199907000-00006.
[92]
FujisawaM, NaitoM, AsayamaI, et al. Effect of calf-thigh intermittent pneumatic compression device after total hip arthroplasty: comparative analysis with plantar compression on the effectiveness of reducing thrombogenesis and leg swelling [J]. J Orthop Sci, 2003, 8 (6): 807-811. DOI: 10.1007/s00776-003-0706-y.
[93]
BarreraLM, PerelP, KerK, et al. Thromboprophylaxis for trauma patients [J]. Cochrane Database Syst Rev, 2013 (3): CD008303. DOI: 10.1002/14651858.CD008303.pub2.
[94]
ProctorMC, GreenfieldLJ, WakefieldTW, et al. A clinical comparison of pneumatic compression devices: the basis for selection [J]. J Vasc Surg, 2001, 34 (3): 459-463; discussion 463-464. DOI: 10.1067/mva.2001.117884.
[95]
ArabiYM, Al-HameedF, BurnsKEA, et al. Adjunctive intermittent pneumatic compression for venous thromboprophylaxis [J]. N Engl J Med, 2019, 380 (14): 1305-1315. DOI: 10.1056/NEJMoa1816150.
[96]
FanCF, JiaL, FangF, et al. Adjunctive intermittent pneumatic compression in hospitalized patients receiving pharmacologic prophylaxis for venous thromboprophylaxis: a systematic review and Meta-analysis [J]. J Nurs Scholarsh, 2020, 52 (4): 397-405. DOI: 10.1111/jnu.12566.
[97]
RappoldJF, SheppardFR, Carmichael IiSP, 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 (1): e000643. DOI: 10.1136/tsaco-2020-000643.
[98]
CastagnaL, MaggioniE, CoppoA, et al. Safe ECMO femoral decannulation by placement of inferior vena cava filter via internal jugular vein [J]. J Artif Organs, 2016, 19 (3): 297-300. DOI: 10.1007/s10047-016-0892-y.
[99]
BikdeliB, ChatterjeeS, DesaiNR, et al. Inferior vena cava filters to prevent pulmonary embolism: systematic review and Meta-analysis [J]. J Am Coll Cardiol, 2017, 70 (13): 1587-1597. DOI: 10.1016/j.jacc.2017.07.775.
[100]
StevensSM, WollerSC, KreuzigerLB, et al. Antithrombotic therapy for VTE disease: second update of the CHEST guideline and expert panel report [J]. Chest, 2021, 160 (6): e545-e608. DOI: 10.1016/j.chest.2021.07.055.
[101]
中华医学会外科学分会血管外科学组，中国医师协会血管外科医师分会，海峡两岸医药卫生交流协会血管外科分会,等.孤立性远端深静脉血栓诊疗建议[J].中华普通外科杂志, 2021, 36 (9): 719-721. DOI: 10.3760/cma.j.cn113855-20210702-00403.
[102]
RajasekharA, StreiffMB. How I treat central venous access device-related upper extremity deep vein thrombosis [J]. Blood, 2017, 129 (20): 2727-2736. DOI: 10.1182/blood-2016-08-693671.
[103]
MonrealM, AlastrueA, RullM, et al. Upper extremity deep venous thrombosis in cancer patients with venous access devices: prophylaxis with a low molecular weight heparin (Fragmin) [J]. Thromb Haemost, 1996, 75 (2): 251-253. DOI: 10.1055/s-0038-1650254.
[104]
VersoM, AgnelliG, BertoglioS, et al. Enoxaparin for the prevention of venous thromboembolism associated with central vein catheter: a double-blind, placebo-controlled, randomized study in cancer patients [J]. J Clin Oncol, 2005, 23 (18): 4057-4062. DOI: 10.1200/JCO.2005.06.084.
[105]
KarthausM, KretzschmarA, KröningH, et al. Dalteparin for prevention of catheter-related complications in cancer patients with central venous catheters: final results of a double-blind, placebo-controlled phase Ⅲ trial [J]. Ann Oncol, 2006, 17 (2): 289-296. DOI: 10.1093/annonc/mdj059.
[106]
KearonC, AklEA, OrnelasJ, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report [J]. Chest, 2016, 149 (2): 315-352. DOI: 10.1016/j.chest.2015.11.026.
[107]
LymanGH, CarrierM, AyC, et al. American Society of Hematology 2021 guidelines for management of venous thromboembolism: prevention and treatment in patients with cancer [J]. Blood Adv, 2021, 5 (4): 927-974. DOI: 10.1182/bloodadvances.2020003442.
[108]
DaviesGA, Lazo-LangnerA, GandaraE, et al. A prospective study of Rivaroxaban for central venous catheter associated upper extremity deep vein thrombosis in cancer patients (Catheter 2) [J]. Thromb Res, 2018, 162: 88-92. DOI: 10.1016/j.thromres.2017.04.003.
[109]
SchifferCA, ManguPB, WadeJC, et al. Central venous catheter care for the patient with cancer: American Society of Clinical Oncology clinical practice guideline [J]. J Clin Oncol, 2013, 31 (10): 1357-1370. DOI: 10.1200/JCO.2012.45.5733.
引用: 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(6) : 561-572.
点击阅读原文，进入书籍宝库，用完记得收藏哦，下次更方便。