摘要
目的 总结瓣膜性心脏病患者经导管主动脉瓣置换术(TAVR)后抗血栓管理的最佳证据。方法 按照“6S”循证资源金字塔证据模型,计算机检索国际指南协作网(GIN)、英国国家卫生与临床优化研究所(NICE)网站、欧洲经皮心血管介入学会(EAPCI)网站、欧洲心脏病学会(ESC)网站、加拿大安大略省注册护士协会(RNAO)网站、美国胸科协会(ATS)网站、英国胸科协会(BTS)网站、澳大利亚JBI循证卫生保健中心、Cochrane Library、美国心脏病学会(ACC)网站、奥地利心脏病学会(ÖKG)/奥地利心脏外科学会(ÖGHTG)网站、苏格兰院际指南网(SIGN)、加拿大心血管学会(CCS)网站、欧洲加速康复外科协会网站、UpToDate、Embase、CINAHL、PubMed、医脉通网站、中国生物医学文献数据库、中国知网、中华医学会指南网站、万方数据知识服务平台关于瓣膜性心脏病患者TAVR后抗血栓管理的文献,检索时限为2010—2023年。由2名研究人员进行文献筛选及内容提取、文献质量评价、证据提取与整合、证据分级和推荐级别的评估。结果 共纳入文献20篇,包括5篇指南、11篇专家共识、4篇系统评价。5篇指南推荐级别均为A级。11篇专家共识中,除8篇文献的条目6评价为“否”外,其他条目均评价为“是”。4篇系统评价的所有条目评价为“是”。通过证据提取与整合,最终形成了瓣膜性心脏病患者TAVR后抗血栓管理的最佳证据,包括个体化评估、无长期抗血栓适应证患者抗血栓方案、有长期抗血栓适应证患者抗血栓方案、术后动态监测、并发症处理、术后早期康复、术后随访、多学科心脏团队的建立与协作8个方面共36条最佳证据。结论 本研究总结的瓣膜性心脏病患者TAVR后抗血栓管理的最佳证据包括8个方面共36条最佳证据,可为临床规范瓣膜性心脏病患者TAVR后抗血栓管理提供借鉴。
Objective To summarize the best evidence of antithrombotic management of patients with valvular heart disease after transcatheter aortic valve replacement(TAVR).Methods According to the"6S"evidence-based resource pyramid model,the literature on antithrombotic management of patients with valvular heart disease after TAVR published in Guideline International Network(GIN),National Institute for Health and Care Excellence(NICE)website,European Association of Percutaneous Cardiovascular Interventions(EAPCI)website,European Society od Cardiology(ESC)website,Registered Nurses'Association of Ontario(RNAO)website,American Thoracic Society(ATS)website,British Thoracic Society(BTS)website,JBI Evidence-Based Healthcare Center in Australia,Cochrane Library,American College of Cardiology(ACC)website,Austrian Society of Cardiology(ÖKG)/Austrian Society of Cardiac Surgery(ÖGHTG)website,Scottish Intercollegiate Guidelines Network(SIGN),Canadian Cardiovascular Society(CCS)website,European Association of Accelerated Rehabilitation Surgeons website,UpToDate,Embase,CINAHL,PubMed,Medlive,China Biomedical Literature Database,CNKI,Chinese Medical Association website,Wanfang Data was searched by the computer.The search period was from 2010 to 2023.Two investigators conducted,literature screening and content extraction,literature quality evaluation,evidence extraction and integration,evidence grading and recommendation level evaluation.Results A total of 20 articles were included,including 5 guidelines,11 expert consensus,4 system assessments.Five guidelines had a recommendation level of A.Among the 11 expert consensus,except for item 6 of 8 expert consensus which was evaluated as"no",all other items were evaluated as"yes".Among the 4 system assessments,all items were evaluated as"yes".Through evidence extraction and integration,the best evidence for antithrombotic management of patients with valvular heart disease after TAVR was ultimately formed,it included 36 best evidences in 8 aspects of individualized assessment,anticoagulation regimen for patients without long-term anticoagulation indications,anticoagulation regimen for patients with long-term anticoagulation indications,postoperative ambulatory monitoring,management of complications,early postoperative rehabilitation,postoperative follow-up,and establishment and collaboration of multidisciplinary cardiac team.Conclusion Best evidence of antithrombotic management of patients with valvular heart disease after TAVR summarized by this study includes 36 best evidences in 8 aspects,it can provide reference for the clinical standardization of antithrombotic management of patients with valvular heart disease after TAVR.
作者
余强芳
李畑波
王咏
蹇朝
李恩
YU Qiangfang;LI Tianbo;WANG Yong;JIAN Zhao;LI En(Department of Cardiovascular Surgery,Second Affiliated Hospital of Army Medical University,Chongqing 400030,China)
出处
《实用心脑肺血管病杂志》
2024年第7期1-9,共9页
Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease
基金
2022年重庆市自然科学基金面上项目(CSTB2022NSCQ-MSX0200)
2022年重庆市自然科学基金创新发展联合基金项目(CSTB2022NSCQ-LZX0076)
陆军军医大学第二附属医院护理科研培育项目(2023HLPY10)。
关键词
心脏瓣膜疾病
瓣膜性心脏病
经导管主动脉瓣置换
抗血栓
循证医学
证据
Heart valve diseases
Valvular heart disease
Transcatheter aortic valve replacement
Antithrombotic
Evidence-based medicine
Evidence
