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中华妇幼临床医学杂志(电子版) ›› 2021, Vol. 17 ›› Issue (01) : 15 -22. doi: 10.3877/cma.j.issn.1673-5250.2021.01.003

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妇产科患者静脉血栓栓塞症风险评估模型的研究现状
张家怡, 张玉泉()   
  • 收稿日期:2020-10-03 修回日期:2021-01-11 出版日期:2021-02-01
  • 通信作者: 张玉泉

Current research status of venous thromboembolism risk assessment models among obstetrics and gynecology patients

Jiayi Zhang, Yuquan Zhang()   

  • Received:2020-10-03 Revised:2021-01-11 Published:2021-02-01
  • Corresponding author: Yuquan Zhang
  • Supported by:
    Project of Medical Innovation Team in Jiangsu Province(SWKJ[2017]No.1)
引用本文:

张家怡, 张玉泉. 妇产科患者静脉血栓栓塞症风险评估模型的研究现状[J]. 中华妇幼临床医学杂志(电子版), 2021, 17(01): 15-22.

Jiayi Zhang, Yuquan Zhang. Current research status of venous thromboembolism risk assessment models among obstetrics and gynecology patients[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2021, 17(01): 15-22.

静脉血栓栓塞症(VTE)是指静脉血管管腔内血液异常凝结,形成血栓而使血管完全或部分阻塞引起血液循环障碍,由此导致的一系列相关病理生理改变的临床疾病。VTE主要包括深静脉血栓形成(DVT)和肺栓塞。妊娠期VTE是一种非常严重的,具有潜在致死性的妊娠并发症。VTE是可预防性疾病,早预防、早发现、早治疗是避免VTE严重后果的重要原则。对妇产科患者利用VTE风险评估模型进行评估,可科学、有效、及时鉴别诊断VTE高危患者,而对其及时采取个性化预防措施,可降低女性患者VTE发生率。目前在妇产科领域研究和应用较为广泛的VTE风险评估模型包括:Caprini、Rogers、Autar及Khorana风险评估模型等。笔者分别拟就妇科与产科领域常用VTE风险评估模型的研究现状进行阐述,旨在为妇产科医师对VTE高危患者的评估提供参考。

Venous thromboembolism (VTE) refers to abnormal coagulation of blood in venous vessels, which forms a thrombus and causes blood vessels completely or partially blocked, and then lead to blood circulation disorders and a series of pathophysiological changes. VTE mainly includes deepvein thrombosis (DVT) and pulmonary embolism.VTE during pregnancy is a very serious and potentially fatal complication. As researches shown, the serious consequences of VTE are almost preventable with the principles of early prevention, early detection, and timely treatment. The key of reducing the morbidity of VTE in female patients is to accurately identify the high-risk groups via VTE risk assessment models, which contributes a lot to the differential diagnosis and personalized precautions. Currently, the widely used VTE risk assessment models include Caprini, Rogers, Autar and Khorana risk assessment models, etc.. In this review, the authors elaborate on current research status of above-mentioned models in the fields of gynecology and obstetrics, which provides a reference for the evaluation of obstetrics and gynecology patients with high-risk of VTE.

[1]
陈倩,胡雅毅. 妊娠相关静脉血栓栓塞的危险因素及其预防决策[J/CD]. 中华妇幼临床医学杂志(电子版),2019,15(6): 623-631. DOI: 10.3877/cma.j.issn.1673-5250.2019.06.004.
[2]
Cantrell LA, Garcia C,Maitland HS. Thrombosis and thromboprophylaxis in gynecology surgery[J]. Clin Obstet Gynecol, 2018, 61(2): 269-277. DOI:10.1097/GRF.000000000000355.
[3]
McLean KC, James AH. Diagnosis and management of VTE in pregnancy[J]. Clin Obstet Gynecol, 2018, 61(2): 206-218. DOI:10.1097/GRF.0000000000000354.
[4]
Grandone E, Di Micco PP, Villani M, et al.Venous thromboembolism in women undergoing assisted reproductive technologies: data from the RIETE registry[J]. Thromb Haemost, 2018,118(11): 1962-1968. DOI:10.1055/s-0038-1673402.
[5]
Abboud J, Rahman AA, Kahale L, et al. Prevention of health care associated venous thromboembolism through implementing VTE prevention clinical practice guidelines in hospitalized medical patients: a systematic review and Meta-analysis[J]. Implement Sci, 2020,15(1):49. DOI: 10.1186/s13012-020-01008-9.
[6]
Rowswell HR, Nokes TJC. Significant reduction in hospital-acquired thrombosis: impact of national risk assessment and real-time feedback[J]. Open Heart,2017,4(2):e000653. DOI: 10.1136/openhrt-2017-000653.
[7]
Chen Y, Dai Y, Song J, et al. Establishment of a risk assessment tool for pregnancy-associated venous thromboembolism and its clinical application: protocol for a prospective observational study in Beijing[J]. BMC Pregnancy Childbirth,2019,19(1):294. DOI: 10.1186/s12884-019-2448-7.
[8]
Caprini JA. Thrombosis risk assessment as a guide to quality patient care[J]. Dis Mon,2005,51(2-3):70-78. DOI:10.1016/j.disamonth.2005.02.003.
[9]
Caprini JA. Risk assessment as a guide to thrombosis prophylaxis[J]. Curr Opin Pulm Med, 2010, 16(5): 448-452. DOI:10.1097/MCP.0b013e32833c3d3e.
[10]
Obi AT, Pannucci CJ, Nackashi A, et al. Validation of the caprini venous thromboembolism risk assessment model in critically ill surgical patients[J]. JAMA Surg, 2015,150(10): 941-948. DOI:10.1001/jamasurg.2015.1841.
[11]
Sterbling HM, Rosen AK, Hachey KJ, et al. Caprini risk model decreases venous thromboembolism rates in thoracic surgery cancer patients[J]. Ann Thorac Surg, 2018, 105(3): 879-885.DOI:10.1016/j.athoracsur.2017.10.013.
[12]
Yago H, Yamaki T, Sasaki Y, et al. Application of the caprini risk assessment model for evaluating postoperative deep vein thrombosis in patients undergoing plastic and reconstructive surgery[J]. Ann Vasc Surg, 2020,65: 82-89.DOI:10.1016/j.avsg.2019.10.082.
[13]
Stroud W, Whitworth JM, Miklic M, et al. Validation of a venous thromboembolism risk assessment model in gynecologic oncology[J]. Gynecol Oncol, 2014,134(1): 160-163.DOI:10.1016/j.ygyno.2014.04.051.
[14]
Shi J, Ye J, Zhuang X, et al. Application value of caprini risk assessment model and elevated tumor-specific D-dimer level in predicting postoperative venous thromboembolism for patients undergoing surgery of gynecologic malignancies[J]. J Obstet Gynaecol Res, 2019, 45(3): 657-664.DOI:10.1111/jog.13832.
[15]
Barber EL,Clarke-Pearson DL. The limited utility of currently available venous thromboembolism risk assessment tools in gynecological oncology patients[J]. Am J Obstet Gynecol, 2016, 215(4): 445.e1-445.e9.DOI:10.1016/j.ajog.2016.04.034.
[16]
娄英华,沈怡.Caprini血栓风险评估模型预测妇科恶性肿瘤手术患者DVT风险的有效性研究[J].东南大学学报(医学版),2017,36(3):333-337.DOI:10.3969/j.issn.1671-6264.2017.03.005.
[17]
Qu H, Li Z, Zhai Z, et al. Predicting of venous thromboembolism for patients undergoing gynecological surgery[J]. Medicine, 2015. 94(39): e1653.DOI:10.1097/MD.0000000000001653.
[18]
郎景和,王辰,瞿红,等. 妇科手术后深静脉血栓形成及肺栓塞预防专家共识[J]. 中华妇产科杂志,2017, 52(10): 649-653. DOI: 10.3760/cma.j.issn.0529-567X.2017.10.001.
[19]
Rogers SO, Kilaru RK, Hosokawa P, et al. Multivariable predictors of postoperative venous thromboembolic events after general and vascular surgery: results from the patient safety in surgery study[J]. J Am Coll Surg, 2007, 204(6): 1211-1221.DOI:10.1016/j.jamcollsurg.2007.02.072.
[20]
Gould MK, Garcia DA, Wren SM, et al. Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines[J]. Chest, 2012, 141(2 Suppl): e227S-e277S.DOI:10.1378/chest.11-2297.
[21]
Heft J, Goulder A, Schneiter M, et al. Venous thromboembolism prediction in postoperative urogynecology patients: the utility of risk assessment tools[J]. Female Pelvic Med Reconstr Surg, 2020, 26(8):e27-e32.DOI:10.1097/SPV.0000000000000780.
[22]
Khorana AA, Kuderer NM, Culakova E, et al. Development and validation of a predictive model for chemotherapy-associated thrombosis[J]. Blood, 2008, 111(10): 4902-4907.DOI:10.1182/blood-2007-10-116327.
[23]
Mandala M, Falanga A, Roila F, et al. Management of venous thromboembolism (VTE) in cancer patients: ESMO clinical practice guidelines[J]. Ann Oncol, 2011, 22(Suppl 6):i85-i92.DOI: 10.1093/annonc/mdr392.
[24]
NCCN.Cancer-associated venous thromboembolic disease.Version 1.2017[M/OL].Fort Washington: NCCN,2017 [2020-12-01].

URL    
[25]
马军,秦叔逵,吴一龙,等. 肿瘤相关静脉血栓栓塞症预防与治疗指南(2019版)[J]. 中国肿瘤临床,2019, 46(13): 653-660.DOI: 10.3969/j.issn.1000-8179.2019.13.765.
[26]
Mulder FI, Candeloro M, Kamphuisen PW, et al. The Khorana score for prediction of venous thromboembolism in cancer patients: a systematic review and Meta-analysis[J]. Haematologica, 2019, 104(6): 1277-1287.DOI:10.3324/haematol.2018.209114.
[27]
van Es N, Franke VF, Middeldorp S, et al. The Khorana score for the prediction of venous thromboembolism in patients with pancreatic cancer[J]. Thromb Res, 2017,150: 30-32.DOI:10.1016/j.thromres.2016.12.013.
[28]
Mansfield AS, Tafur AJ, Wang CE, et al. Predictors of active cancer thromboembolic outcomes: validation of the Khorana score among patients with lung cancer[J]. J Thromb Haemost, 2016, 14(9): 1773-1778.DOI:10.1111/jth.13378.
[29]
Reboucas D, Costa M, Thuler L, et al. Breast cancer-associated venous thromboembolism: a case-control study[J]. Breast, 2016,28: 84-88.DOI:10.1016/j.breast.2016.04.015.
[30]
Gerotziafas GT, Taher A, Abdel-Razeq H, et al. A predictive score for thrombosis associated with breast, colorectal, lung, or ovarian cancer: the prospective COMPASS-cancer-associated thrombosis study[J]. Oncologist, 2017,22(10): 1222-1231.DOI:10.1634/theoncologist.2016-0414.
[31]
王鑫丹,黄静,赵冰冰,等.不同风险评估模型对妇科恶性肿瘤相关深静脉血栓形成的预测价值比较[J]. 现代妇产科进展,2018,27(6):409-413.DOI:10.13283/j.cnki.xdfckjz.2018.06.003.
[32]
Rupa-Matysek J, Lembicz M, Rogowska EK, et al. Evaluation of risk factors and assessment models for predicting venous thromboembolism in lung cancer patients[J]. Med Oncol, 2018, 35(5): 63.DOI:10.1007/s12032-018-1120-9.
[33]
Spyropoulos AC, Eldredge JB, Anand LN, et al. External validation of a venous thromboembolic risk score for cancer outpatients with solid tumors: the COMPASS-CAT venous thromboembolism risk assessment model[J]. Oncologist, 2020,25(7):e1083-e1090.DOI: 10.1634/theoncologist.2019-0482.
[34]
Winter MP, Schernthaner GH,Lang IM. Chronic complications of venous thromboembolism[J]. J Thromb Haemost, 2017,15(8): 1531-1540.DOI: 10.1111/jth.13741.
[35]
Funda B, Merdiye S,Ricky A, et al. Risk level analysis for deep vein thrombosis (DVT): a study of Turkish patients undergoing major orthopedic surgery[J]. J Vasc Nurs, 2015,33(3): 100-105.DOI:10.1016/j.jvn.2015.01.004.
[36]
何翠琴,陈新萍. 基于Autar量表的护理干预对妇科手术患者下肢深静脉血栓的预防研究[J]. 实用临床医药杂志,2016, 20(22): 113-115.DOI:10.7619/jcmp.201622035.
[37]
辛丽,甘秀妮.Autar量表在妇科腹腔镜术后预防深静脉血栓中的应用研究[J]. 全科护理,2015,13(15): 1369-1371. DOI: 10.3969/j.issn.1674-4748.2015.15.001.
[38]
佟彤,高红,孙涛.四种常见风险评估模型对妇科恶性肿瘤患者术后静脉血栓栓塞症预测价值的对比研究[J].实用心脑肺血管病杂志,2018,26(7):94-98.DOI: 10.3969/j.issn.1008-5971.2018.07.21.
[39]
Ewins K,Ni Ainle F. VTE risk assessment in pregnancy[J]. Res Pract Thromb Haemost, 2019. 4(2): 183-192.DOI:10.1002/rth2.12290.
[40]
Royal College of Obstetricians and Gynaecologists. Thrombosis and embolism during pregnancy and the puerperium, reducing the risk (Green-top Guideline No.37a)[EB/OL]. (2015-04-13)[2020-12-01].

URL    
[41]
Tran JP, Stribling SS, Ibezim UC, et al. Performance of risk assessment models for peripartum thromboprophylaxis[J]. Reprod Sci, 2019, 26(9): 1243-1248.DOI:10.1177/1933719118813197.
[42]
张丽兴,谢增霞,刘彩云,等. RCOG血栓风险评估模型在产妇下肢静脉血栓栓塞症中的预测价值研究[J]. 中国医学创新,2016,13(12): 25-27.DOI:10.3969/j.issn.1674-4985.2016.12.007.
[43]
Main EK, Goffman D, Scavone BM, et al.National partnership for maternal safety: consensus bundle on obstetric hemorrhage[J]. Obstet Gynecol,2015,126(1):155-162. DOI: 10.1097/AOG.0000000000000869.
[44]
Dargaud Y, Rugeri L, Vergnes MC, et al. A risk score for the management of pregnant women with increased risk of venous thromboembolism: a multicentre prospective study[J].Br J Haematol, 2009,145(6):825-835. DOI:10.1111/j.1365-2141.2009.07698.x.
[45]
Dargaud Y, Rugeri L, Ninet J, et al. Management of pregnant women with increased risk of venous thrombosis[J]. Int J Gynecol Obstet, 2005, 90(3): 203-207.DOI:10.1016/j.ijgo.2005.05.003.
[46]
Bates SM, Middeldorp S, Rodger M, et al. Guidance for the treatment and prevention of obstetric-associated venous thromboembolism[J].J Thromb Thrombolysis,2016,41(1):92-128. DOI:10.1007/s11239-015-1309-0.
[47]
Dargaud Y, Rugeri L, Fleury C, et al. Personalized thromboprophylaxis using a risk score for the management of pregnancies with high risk of thrombosis: a prospective clinical study[J]. J Thromb Haemost, 2017,15(5): 897-906.DOI:10.1111/jth.13660.
[48]
Quellec LS,Desjonqueres A,Rugeri L,et al.Combined life-threatening thromboses and hemorrhages in a patient with afibrinogenemia and antithrombin deficiency[J].Thromb J,2018,16:6.DOI: 10.1186/s12959-018-0162-8.
[49]
Croles FN, Nasserinejad K, Duvekot JJ,et al. Pregnancy, thrombophilia, and the risk of a first venous thrombosis: systematic review and bayesian Meta-analysis[J].BMJ,2017,359:j4452.DOI:10.1136/bmj.j4452.
[50]
张玉泉,杨晓清,施沁.重视妇产科静脉血栓栓塞症的综合预防[J].中国实用妇科与产科杂志,2018,34(7):705-708.DOI:10.19538/j.fk2018070101.
[51]
田博,宋春凤,李辉,等.Caprini和Rogers风险评估模型联合使用可以提高胸外科术后患者筛选静脉血栓栓塞症的准确性[J/CD].中华胸部外科电子杂志,2017,4(3):186-189.DOI: 10.3877/cma.j.issn.2095-8773.2017.03.11.
[52]
车焱.我国妇产科静脉血栓栓塞症发生率研究现状[J].中国实用妇科与产科杂志,2018,34(7):709-713. DOI:10.19538/j.fk2018070102.
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