围手术期应用胃肠外直接凝血酶抑制剂的专家共识OA

OBJECTIVE To form an expert consensus on the clinical application of parenteral direct thrombin inhibitors(DTIs)in patients during the perioperative period.METHODS Led by Sichuan Academy of Medical Sciences&Sichuan Provincial People's Hospital(the Affiliated Hospital of UESTC),a multidisciplinary working group was established.Through literature review and the Delphi method,clinical questions related to the rational perioperative use of parenteral DTIs were identified.A structured design was adopted using the"Population-Intervention-Comparison-Outcome"framework;systematic searches were conducted in CNKI,Medline,Embase and other databases.Relevant evidence from randomized controlled trials and cohort studies was included and synthesized.Evidence quality was assessed using the Grades of Recommendations Assessment,Development and Evaluation(GRADE)approach,and recommendations were formulated through multiple rounds of Delphi surveys and expert consensus meetings.RESULTS&CONCLUSIONS Seven recommendations(each with an expert consensus rate exceeding 90%)on the use of parenteral DTIs in perioperative patients were developed.These recommendations specify drug selection,dosing ranges,key monitoring points,and safety management strategies for parenteral DTIs in various scenarios,including the perioperative period of ventricular assist device implantation,the perioperative period of cardiac surgery,perioperative patients with lower-extremity atherosclerotic disease,the perioperative period of percutaneous coronary intervention in patients with acute coronary syndrome,the perioperative period of carotid artery stenting in patients with carotid stenosis,the perioperative period of patients with right heart thrombosis,and patients who develop related thrombosis and dysfunction after a central venous catheter insertion.In addition,warning and management pathways for perioperative bleeding and thrombotic events were proposed.This expert consensus,which is formulated based on the best available evidence,provides evidence-based guidance for standardized and individualized use of parenteral DTIs in perioperative period.