欧洲血管外科学会2023版《血管疾病抗血栓治疗临床实践指南》解读—下肢动脉硬化性疾病

doi:10.7659/j.issn.1005-6947.2023.06.002

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欧洲血管外科学会2023版《血管疾病抗血栓治疗临床实践指南》解读—下肢动脉硬化性疾病
DOI:
                        10.7659/j.issn.1005-6947.2023.06.002
                    
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作者单位:1.中南大学湘雅医院，血管外科，湖南 长沙 410008;2.中南大学湘雅医院，国家老年疾病临床医学研究中心，湖南 长沙 410008
作者简介:杨璞，中南大学湘雅医院副主任医师，主要从事血管外科方面的研究。
通信作者:黄建华，Email: 13507319258@139.com
基金项目:

Interpretation of the European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines for Antithrombotic Therapy in Vascular Diseases — atherosclerotic lower extremity arterial disease

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Affiliation:

1.Department of Vascular Surgery, Xiangya Hospital, Central South University, Changsha 410008, China;2.National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China

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欧洲血管外科学会（ESVS）首次发布了2023版《血管疾病抗血栓治疗临床实践指南》，对下肢动脉硬化性疾病（LEAD）的抗血栓策略进行了详细的介绍和更新，并给出了21条具体的推荐。LEAD患病率和相关的公共卫生费用都在不断增加，抗血栓治疗是LEAD患者的治疗基石。因此，笔者根据指南的循证医学证据，结合临床实际，重点对LEAD的抗血栓策略进行解读，希望能够帮助医务工作者更好地理解和遵循指南。

Abstract:

The European Society for Vascular Surgery (ESVS) has released the 2023 edition of the "Clinical Practice Guidelines on Antithrombotic Therapy for Vascular Diseases" for the first time. The guidelines provide a detailed introduction and updates on the antithrombotic strategies for atherosclerotic lower extremity arterial disease (LEAD), along with 21 specific recommendations. The prevalence of LEAD and its associated public health costs continue to rise, making antithrombotic therapy a cornerstone in treating LEAD patients. Therefore, the authors interpret the antithrombotic strategies for LEAD, focusing on evidence-based medicine from the guidelines and considering clinical practice, hoping to assist healthcare professionals in better understanding and adhering to the guidelines.

表 3 慢性症状性LEAD患者发生MACE或MALE的风险因素Table 3 Risk factors for MACE or MALE in patients with chronic symptomatic LEAD

表 2 根据COMPASS和VOYAGER标准被定义为高出血风险的患者Table 2 Patients defined as having high bleeding risk according to the COMPASS and VOYAGER criteria

图1 慢性症状性LEAD患者的抗血栓治疗注：1）出血高风险（满足1项即可）：临床医生认定的高出血风险人群；1个月内发生卒中；出血、腔隙性脑梗、伴有凝血功能障碍的肝脏疾病病史。缺血高风险（满足1项即可）：超过1个部位的有症状的动脉疾病；慢性肾脏疾病、需要透析支持的肾功能衰竭；糖尿病；心力衰竭；慢性肢体缺血；慢性下肢动脉疾病的急性表现；既往下肢截肢；既往下肢血运重建Fig.1 Antithrombotic therapy for patients with chronic symptomatic LEAD Note: 1) High bleeding risk (meeting one criterion is sufficient): individuals identified by the treating physician as having a high risk of bleeding; history of stroke within the past month; history of bleeding, lacunar cerebral infarction, or liver disease with coagulation dysfunction. High ischemic risk (meeting one criterion is sufficient): symptomatic arterial disease in more than one location; chronic kidney disease or renal failure requiring dialysis; diabetes; heart failure; chronic limb ischemia; acute manifestations of chronic lower extremity arterial disease; previous lower limb amputation; previous lower limb revascularization

图2 LEAD患者腔内治疗后的抗血栓策略注：1）出血高风险的定义使用VOYAGER方案Fig.2 Antithrombotic Strategies After Endovascular Treatment in LEAD Patients Note: 1) The definition of high bleeding risk is based on the VOYAGER criteria

图3 LEAD患者下肢旁路术后的抗血栓策略注：1）出血高风险的定义使用VOYAGER方案Fig.3 Antithrombotic strategies after lower extremity bypass surgery in LEAD patients Note: 1) The definition of high bleeding risk is based on the VOYAGER criteria

表 1 欧洲心脏病学会证据分级系统的证据等级及推荐强度Table 1 Evidence grades and recommendation strength of the European Society of Cardiology evidence grading system

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杨璞,盛昌,王伟,黄建华.欧洲血管外科学会2023版《血管疾病抗血栓治疗临床实践指南》解读—下肢动脉硬化性疾病[J].中国普通外科杂志,2023,32(6):815-823.
DOI:10.7659/j. issn.1005-6947.2023.06.002

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收稿日期:2023-05-26
最后修改日期:2023-06-04
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在线发布日期: 2023-07-07

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