胃肠外直接凝血酶抑制剂在特殊人群中的临床应用专家共识OA

OBJECTIVE To form an expert consensus addressing clinical issues regarding the use of parenteral direct thrombin inhibitors (DTIs) in special populations.METHODS Led by the Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital(the Affiliated Hospital of UESTC),a multidisciplinary working group was formed comprising experts from multiple fields,including clinical pharmacy,cardiac surgery,obstetrics,pediatrics and evidence-based medicine.Through literature review and the Delphi method,clinical questions regarding the efficacy and safety of parenteral DTIs used in special populations were identified.A structured design was adopted using the"Population-Intervention-Comparison-Outcome"(PICO)framework;systematic searches were conducted in CJFD,PubMed,Embase and other databases.Relevant evidence from randomized controlled trials,cohort studies and systematic reviews were included and synthesized.Evidence quality was assessed using the Grading of Recommendations Assessment,Development and Evaluation(GRADE)approach,and recommendations were formulated through three rounds of Delphi surveys and expert consensus meetings.RESULTS&CONCLUSIONS Seven clinical questions were ultimately selected(with a consensus rate exceeding 90％),resulting in the formulation of seven recommendations on the use of parenteral DTIs in special populations,including children,pregnant women,patients with hepatic or renal impairment,patients with mesenteric venous thrombosis,and individuals with thrombophilia.These recommendations clarify the preferred agents,dosing ranges,monitoring parameters,and safety management strategies for parenteral DTIs in these special populations.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 special populations.