背景:用于治疗静脉血栓栓塞症的直接口服抗凝剂得到了有力的临床试验证据的支持。尽管发布了指南,全科医生面临着越来越复杂的决策,在某些实际情况下,实施仍然是次优的。
方法:进行了两个阶段的正式共识练习,以制定共识声明和摘要指南,促进欧洲通才医师对静脉血栓栓塞患者直接口服抗凝药的最佳管理。向一个广泛的小组分发了一份在线问卷(第一阶段),随后由专家组进行了虚拟小组讨论(第二阶段)。第一阶段的声明涵盖了九个管理领域,并通过文献综述和专家指导委员会制定。参与者根据他们的协议水平对陈述进行评级。在第2阶段的讨论和迭代改进之前,对第1阶段的响应进行了整理和分析。
结果:来自欧洲的56名参与者对第一阶段做出了回应。大多数人都有全科医生的工作经验。共识表明,直接口服抗凝药是治疗静脉血栓栓塞症患者的首选治疗方法。在开始治疗和延长治疗时,在3至6个月时进行审查,以重新评估治疗效果和风险状况。直接口服抗凝剂的选择应基于患者的个体因素,并包括临床医生和患者之间的共同治疗选择;唯一需要具体指导的患者亚组是癌症患者。
结论:结果表明了对最佳实践的赞赏,但突出了临床实践中的挑战。提供的患者路径和共识建议,旨在突出一般实践决策的关键考虑因素,并有助于最佳的静脉血栓栓塞治疗。
BACKGROUND: Direct oral anticoagulants for the treatment of venous thromboembolism are supported by robust clinical trial evidence. Despite published guidance, general practitioners are faced with increasingly complex decisions and implementation remains sub-optimal in certain real-world scenarios.
METHODS: A two stage formal
consensus exercise was performed to formulate
consensus statements and a summary guide, facilitating optimal management of direct oral anticoagulants in venous thromboembolism patients by generalist physicians across Europe. An online questionnaire distributed to a broad panel (Phase 1), followed by a virtual panel discussion by an expert group (Phase 2) were conducted. Phase 1 statements covered nine management domains, and were developed via a literature review and expert steering committee. Participants rated statements by their level of agreement. Phase 1 responses were collated and analysed prior to discussion and iterative refinement in Phase 2.
RESULTS: In total 56 participants from across Europe responded to Phase 1. The majority had experience working as general practitioners.
Consensus indicated that direct oral anticoagulants are the treatment of choice for managing patients with venous thromboembolism, at initiation and for extended treatment, with a review at three to six months to re-assess treatment effect and risk profile. Direct oral anticoagulant choice should be based on individual patient factors and include shared treatment choice between clinicians and patients; the only sub-group of patients requiring specific guidance are those with cancer.
CONCLUSIONS: Results demonstrate an appreciation of best practices, but highlight challenges in clinical practice. The patient pathway and
consensus recommendations provided, aim to highlight key considerations for general practice decision making, and aid optimal venous thromboembolism treatment.