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
Ann Intensive Care
; 13(1): 1-27, 20230511. tab
Artículo
en Inglés
| BIGG - guías GRADE
| ID: biblio-1434930
Biblioteca responsable:
BR1.1
ABSTRACT
To develop evidence-based clinical practice guidelines on venous thromboembolism (VTE) prevention in adults with trauma in inpatient settings. 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). The panel issued 12 clinical practice recommendationsone, 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 intermediatehigh 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. 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.
Texto completo:
Disponible
Colección:
Bases de datos temática
Contexto en salud:
Agenda de Salud Sostenible para las Américas
/
ODS3 - Salud y Bienestar
Problema de salud:
Objetivo 9: Enfermedades no transmisibles y salud mental
/
Meta 3.4: Reducir las muertes prematuras por enfermedades no transmisibles
Base de datos:
BIGG - guías GRADE
Asunto principal:
Traumatismos de la Médula Espinal
/
Heparina de Bajo-Peso-Molecular
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Tromboembolia Venosa
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Lesiones Traumáticas del Encéfalo
Tipo de estudio:
Guía de práctica clínica
/
Estudio pronóstico
Idioma:
Inglés
Revista:
Ann Intensive Care
Año:
2023
Tipo del documento:
Artículo
Institución/País de afiliación:
20Trauma Center, King Saud Medical City/SA
/
Alfaisal University/SA
/
Critical Care Department/SA
/
Imam Abdulrahman Bin Faisal University/SA
/
First Clinic+SA
/
Jazan University/SA
/
King Abdulaziz Medical City/SA
/
King Abdulaziz University/SA
/
King Abdullah International Medical Research Center/SA
/
King Faisal Specialist Hospital and Research Cente/SA