JAMA:静脉血栓栓塞的抗血栓治疗

GUIDELINE TITLE Antithrombotic Therapy for VTE Disease: Second Update of the CHEST Guideline and Expert Panel Report

DEVELOPER AND FUNDING SOURCE American College of Chest Physicians

RELEASE DATE August 2, 2021

PRIOR VERSIONS December 2012 (Antithrombotic Therapy and Prevention of Thrombosis) and February 2016 (Antithrombotic Therapy for VTE Disease)

TARGET POPULATION Adult patients with VTE

MAJOR RECOMMENDATIONS

• 1. Patients with low-risk pulmonary embolism should receive outpatient treatment (strong recommendation, low certainty of evidence)低风险肺栓塞患者应接受门诊治疗（强烈推荐，证据确定性较低）
• 2. Direct-acting oral anticoagulants (DOACs) should be used to treat acute VTE for the 3-month treatment phase (strong recommendation, moderate evidence)应在3个月治疗期内使用直接作用口服抗凝剂 (DOAC) 治疗急性VTE（强烈推荐，中等证据）
• 3. Oral Xa inhibitors should be used to treat acute VTE in a patient with cancer for both the initial and extended treatment phases (strong recommendation, moderate evidence)口服 Xa 抑制剂应在初始和扩展治疗期用于治疗癌症患者的急性VTE（强推荐，中等证据）
• 4. In patients with acute VTE, treat with full dose DOACs for 3 months (strong recommendation, moderate evidence) followed by reduced-dose DOACs for extended therapy if indicated (weak recommendation, moderate evidence)在急性 VTE 患者中，以全剂量 DOAC 治疗3个月（强推荐，中度证据），然后根据指征降低剂量 DOAC 进行延长治疗（弱推荐，中度证据）
• 5. Extended anticoagulation therapy beyond 3 months is not routinely recommended in patients with major or minor transient risk factors (strong recommendation, moderate evidence)对于具有重大或轻微一过性风险因素的患者，不常规推荐延长抗凝治疗超过3个月（强推荐，中度证据）