Saudi Critical Care Society clinical practice guidelines on the prevention of venous thromboembolism in adults with trauma: reviewed for evidence-based integrity and endorsed by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine.

Autor: Amer M; Medical/Critical Pharmacy Division, King Faisal Specialist Hospital and Research Center, Al Mathar Ash Shamali, Riyadh, 11564, Saudi Arabia. mamer@kfshrc.edu.sa.; College of Medicine and Pharmacy, Alfaisal University, Riyadh, Saudi Arabia. mamer@kfshrc.edu.sa., Alshahrani MS; Department of Emergency and Critical Care, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia., Arabi YM; Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia., Al-Jedai A; College of Medicine and Pharmacy, Alfaisal University, Riyadh, Saudi Arabia.; Therapeutic Affairs, Ministry of Health, Riyadh, Saudi Arabia., Alshaqaq HM; Emergency Medicine Department, King Saud Medical City, Riyadh, Saudi Arabia., Al-Sharydah A; Diagnostic and Interventional Radiology Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia., Al-Suwaidan FA; Clinical Excellence Administration and King Fahad Medical City, Second Health Cluster in Riyadh, Ministry of Health, Riyadh, Saudi Arabia., Aljehani H; Department of Interventional Neuroradiology, Neurosurgery, Neurocritical Care, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia., Nouh T; Trauma and Acute Care Surgery Unit, King Saud University, Riyadh, Saudi Arabia., Mashbari H; Department of Surgery, Jazan University, Jazan, Saudi Arabia., Tarazan N; Department of Medicine, McMaster University, Hamilton, Canada., Alqahtani S; Department of Orthopedic Surgery, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia., Tashkandi W; Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia.; Department of Critical Care, Fakeeh Care Group, Jeddah, Saudi Arabia., Maghrabi K; Department of Critical Care Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia., Albugami M; Department of Internal Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia., Hashim S; Pulmonary and Critical Care Department, International Medical Center/First Clinic, Jeddah, Saudi Arabia., Alsubaie NM; Department of Surgery, King Saud University Medical City, Riyadh, Saudi Arabia., Alsenani M; Trauma Center, King Saud Medical City, Riyadh, Saudi Arabia., Algethamy H; Department of Anesthesia and Critical Care, King Abdulaziz University, Jeddah, Saudi Arabia., Alshammari TM; College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia., Alaklabi A; Department of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia., Ismail N; Department of Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia., Altawil ES; Pharmacy Department, Clinical Pharmacy Services, King Saud University Medical City, Riyadh, Saudi Arabia., Elhazmi A; Dr Sulaiman Al-Habib Medical Group, Critical Care Department, Riyadh, Saudi Arabia., Nahhas A; Department of Critical Care Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia., Aljuaid M; Clinical Nursing Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia., Alsadoon N; Alshaya International Trading Company, Riyadh, Saudi Arabia., Binbraik Y; Department of Medicine, McMaster University, Hamilton, Canada.; Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia., Yuan Y; Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Canada., Alhazzani W; Department of Medicine, McMaster University, Hamilton, Canada.; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.; Department of Critical Care, College of Medicine, King Saud University, Riyadh, Saudi Arabia.; Scientific Research Center, Directorate General of Armed Forces Medical Services, Riyadh, Saudi Arabia.
Jazyk: angličtina
Zdroj: Annals of intensive care [Ann Intensive Care] 2023 May 11; Vol. 13 (1), pp. 41. Date of Electronic Publication: 2023 May 11.
DOI: 10.1186/s13613-023-01135-8
Abstrakt: Background: To develop evidence-based clinical practice guidelines on venous thromboembolism (VTE) prevention in adults with trauma in inpatient settings.
Methods: The Saudi Critical Care Society (SCCS) sponsored guidelines development and included 22 multidisciplinary panel members who completed conflict-of-interest forms. The panel developed and answered structured guidelines questions. For each question, the literature was searched for relevant studies. To summarize treatment effects, meta-analyses were conducted or updated. Quality of evidence was assessed using the Grading Recommendations, Assessment, Development, and Evaluation (GRADE) approach, then the evidence-to-decision (EtD) framework was used to generate recommendations. Recommendations covered the following prioritized domains: timing of pharmacologic VTE prophylaxis initiation in non-operative blunt solid organ injuries; isolated blunt traumatic brain injury (TBI); isolated blunt spine trauma or fracture and/or spinal cord injury (SCI); type and dose of pharmacologic VTE prophylaxis; mechanical VTE prophylaxis; routine duplex ultrasonography (US) surveillance; and inferior vena cava filters (IVCFs).
Results: The panel issued 12 clinical practice recommendations-one, a strong recommendation, 10 weak, and one with no recommendation due to insufficient evidence. The panel suggests starting early pharmacologic VTE prophylaxis for non-operative blunt solid organ injuries, isolated blunt TBIs, and SCIs. The panel suggests using low molecular weight heparin (LMWH) over unfractionated heparin (UFH) and suggests either intermediate-high dose LMWH or conventional dosing LMWH. For adults with trauma who are not pharmacologic candidates, the panel strongly recommends using mechanical VTE prophylaxis with intermittent pneumatic compression (IPC). The panel suggests using either combined VTE prophylaxis with mechanical and pharmacologic methods or pharmacologic VTE prophylaxis alone. Additionally, the panel suggests routine bilateral lower extremity US in adults with trauma with elevated risk of VTE who are ineligible for pharmacologic VTE prophylaxis and suggests against the routine placement of prophylactic IVCFs. Because of insufficient evidence, the panel did not issue any recommendation on the use of early pharmacologic VTE prophylaxis in adults with isolated blunt TBI requiring neurosurgical intervention.
Conclusion: The SCCS guidelines for VTE prevention in adults with trauma were based on the best available evidence and identified areas for further research. The framework may facilitate adaptation of recommendations by national/international guideline policymakers.
(© 2023. The Author(s).)
Databáze: MEDLINE
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