（血液）高凝状态

急症入院或重症监护的患者应进行静脉血栓栓塞风险评估；如果此类患者有一个或多个额外的危险因素，住院期间应该接受血栓预防治疗，直到出院。[100]Kahn SR, Lim W, Dunn AS, et al. Prevention of VTE in nonsurgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(suppl 2):e195S-226S.http://journal.publications.chestnet.org/article.aspx?articleID=1159462http://www.ncbi.nlm.nih.gov/pubmed/22315261?tool=bestpractice.com[121]National Institute for Health and Care Excellence. Venous thromboembolism: reducing the risk for patients in hospital. Clinical guideline 92. June 2015. http://www.nice.org.uk/ (last accessed 26 October 2016).http://www.nice.org.uk/guidance/cg92/chapter/introduction

没有出血风险的患者应该接受药物预防。

剂量视适应症而定；向当地专科医生咨询治疗方案作为剂量指导。

急症入院或重症监护的患者应进行静脉血栓栓塞风险评估；如果此类患者有一个或多个额外的危险因素，住院期间应该接受血栓预防治疗，直到出院。[100]Kahn SR, Lim W, Dunn AS, et al. Prevention of VTE in nonsurgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(suppl 2):e195S-226S.http://journal.publications.chestnet.org/article.aspx?articleID=1159462http://www.ncbi.nlm.nih.gov/pubmed/22315261?tool=bestpractice.com[121]National Institute for Health and Care Excellence. Venous thromboembolism: reducing the risk for patients in hospital. Clinical guideline 92. June 2015. http://www.nice.org.uk/ (last accessed 26 October 2016).http://www.nice.org.uk/guidance/cg92/chapter/introduction

出血风险高的患者应该接受机械性血栓预防。包括梯度压力袜和使用间歇充气加压设备。[100]Kahn SR, Lim W, Dunn AS, et al. Prevention of VTE in nonsurgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(suppl 2):e195S-226S.http://journal.publications.chestnet.org/article.aspx?articleID=1159462http://www.ncbi.nlm.nih.gov/pubmed/22315261?tool=bestpractice.com

如果长期使用，设备每天只能短时间取下（如当患者活动或洗澡时）。

如果出血的风险降低，应该考虑进行药物血栓预防。

非卧床的肿瘤患者进行血栓预防存在争议，不推荐。[123]Lyman GH, Khorana AA, Kuderer NM, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2013;31:2189-2204.http://jco.ascopubs.org/content/31/17/2189.fullhttp://www.ncbi.nlm.nih.gov/pubmed/23669224?tool=bestpractice.com

接受沙立度胺或其衍生物结合化疗或地塞米松治疗的多发性骨髓瘤患者，可从同时使用低分子量肝素 (LMWH) 或低剂量阿司匹林中获益。[124]Lyman GH, Bohlke K, Khorana AA, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology clinical practice guideline update 2014. J Clin Oncol. 2015;33:654-656.http://jco.ascopubs.org/content/33/6/654.longhttp://www.ncbi.nlm.nih.gov/pubmed/25605844?tool=bestpractice.com[125]El Accaoui RN, Shamseddeen WA, Taher AT. Thalidomide and thrombosis. A meta-analysis. Thromb Haemost. 2007;97:1031-1036.http://www.ncbi.nlm.nih.gov/pubmed/17549307?tool=bestpractice.com沙立度胺（或衍生物）治疗期间应该给予预防药低分子量肝素或阿司匹林。

剂量视适应症而定；向当地专科医生咨询治疗方案作为剂量指导。

在重大癌症手术后进行 7 到 10 天的血栓预防（LMWH 或 UFH），同时考虑在重大腹部或骨盆手术后延长血栓预防治疗达28 天。[124]Lyman GH, Bohlke K, Khorana AA, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology clinical practice guideline update 2014. J Clin Oncol. 2015;33:654-656.http://jco.ascopubs.org/content/33/6/654.longhttp://www.ncbi.nlm.nih.gov/pubmed/25605844?tool=bestpractice.com

剂量视适应症而定；向当地专科医生咨询治疗方案作为剂量指导。

具有较高出血风险的患者应当在住院期间接受机械性血栓预防（直至出院后 28 天）。[100]Kahn SR, Lim W, Dunn AS, et al. Prevention of VTE in nonsurgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(suppl 2):e195S-226S.http://journal.publications.chestnet.org/article.aspx?articleID=1159462http://www.ncbi.nlm.nih.gov/pubmed/22315261?tool=bestpractice.com

如果长期使用，设备每天只能短时间取下（如当患者活动或洗澡时）。

如果出血的风险降低，应该考虑进行药物血栓预防。

低风险患者无需进行血栓预防，早期且频繁的活动就足够了。

接受一般手术具有中等静脉血栓栓塞风险的患者应当接受血栓预防。[120]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. Chest. 2012;141(suppl 2):e227S-277S.http://journal.publications.chestnet.org/article.aspx?articleid=1159472http://www.ncbi.nlm.nih.gov/pubmed/22315263?tool=bestpractice.com

没有出血风险的患者应该接受药物预防。[120]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. Chest. 2012;141(suppl 2):e227S-277S.http://journal.publications.chestnet.org/article.aspx?articleid=1159472http://www.ncbi.nlm.nih.gov/pubmed/22315263?tool=bestpractice.com

治疗应该一直持续至出院。

剂量视适应症而定；向当地专科医生咨询治疗方案作为剂量指导。

出血风险高的患者应该接受机械性预防。[120]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. Chest. 2012;141(suppl 2):e227S-277S.http://journal.publications.chestnet.org/article.aspx?articleid=1159472http://www.ncbi.nlm.nih.gov/pubmed/22315263?tool=bestpractice.com

如果长期使用，设备每天只能短时间取下（如当患者活动或洗澡时）。

如果出血的风险降低，应该考虑进行药物血栓预防。

考虑进行持续治疗直至出院。

接受普通外科手术的无高出血风险的静脉血栓栓塞高危患者应该同时接受药物血栓预防（低分子量肝素、普通肝素或磺达肝素）和机械性血栓预防。[120]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. Chest. 2012;141(suppl 2):e227S-277S.http://journal.publications.chestnet.org/article.aspx?articleid=1159472http://www.ncbi.nlm.nih.gov/pubmed/22315263?tool=bestpractice.com[121]National Institute for Health and Care Excellence. Venous thromboembolism: reducing the risk for patients in hospital. Clinical guideline 92. June 2015. http://www.nice.org.uk/ (last accessed 26 October 2016).http://www.nice.org.uk/guidance/cg92/chapter/introduction

治疗应该一直持续至出院。

剂量视适应症而定；向当地专科医生咨询治疗方案作为剂量指导。

出血风险高的患者应该接受机械性血栓预防。[120]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. Chest. 2012;141(suppl 2):e227S-277S.http://journal.publications.chestnet.org/article.aspx?articleid=1159472http://www.ncbi.nlm.nih.gov/pubmed/22315263?tool=bestpractice.com[121]National Institute for Health and Care Excellence. Venous thromboembolism: reducing the risk for patients in hospital. Clinical guideline 92. June 2015. http://www.nice.org.uk/ (last accessed 26 October 2016).http://www.nice.org.uk/guidance/cg92/chapter/introduction

治疗应该一直持续至出院。

如果长期使用，设备每天只能短时间取下（如当患者活动或洗澡时）。

如果出血的风险降低，应该考虑进行药物血栓预防。

接受妇科或泌尿外科手术的患者应该接受低分子量肝素或普通肝素和/或机械性血栓预防，术前即开始使用且患者卧床期间维持使用。[120]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. Chest. 2012;141(suppl 2):e227S-277S.http://journal.publications.chestnet.org/article.aspx?articleid=1159472http://www.ncbi.nlm.nih.gov/pubmed/22315263?tool=bestpractice.com[121]National Institute for Health and Care Excellence. Venous thromboembolism: reducing the risk for patients in hospital. Clinical guideline 92. June 2015. http://www.nice.org.uk/ (last accessed 26 October 2016).http://www.nice.org.uk/guidance/cg92/chapter/introduction

剂量视适应症而定；向当地专科医生咨询治疗方案作为剂量指导。

高出血风险的患者应该接受机械性血栓预防，术前即开始使用且患者卧床期间维持使用。[120]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. Chest. 2012;141(suppl 2):e227S-277S.http://journal.publications.chestnet.org/article.aspx?articleid=1159472http://www.ncbi.nlm.nih.gov/pubmed/22315263?tool=bestpractice.com[121]National Institute for Health and Care Excellence. Venous thromboembolism: reducing the risk for patients in hospital. Clinical guideline 92. June 2015. http://www.nice.org.uk/ (last accessed 26 October 2016).http://www.nice.org.uk/guidance/cg92/chapter/introduction

如果长期使用，设备每天只能短时间取下（如当患者活动或洗澡时）。

如果出血的风险降低，应该考虑进行药物血栓预防。

接受全髋关节或膝关节置换术的患者应该接受低分子量肝素、普通肝素，磺达肝素、达比加群、阿哌沙班、利伐沙班、阿司匹林或华法林治疗，目标国际标准化比值为 2.5，持续至术后 10 至 35 天。[121]National Institute for Health and Care Excellence. Venous thromboembolism: reducing the risk for patients in hospital. Clinical guideline 92. June 2015. http://www.nice.org.uk/ (last accessed 26 October 2016).http://www.nice.org.uk/guidance/cg92/chapter/introduction[122]Falck-Ytter Y, Francis CW, Johanson NA, et al. Prevention of VTE in orthopedic surgery patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(suppl 2):e278S-325S.http://journal.publications.chestnet.org/article.aspx?articleid=1159591http://www.ncbi.nlm.nih.gov/pubmed/22315265?tool=bestpractice.com利伐沙班和达比加群都是新的口服抗凝药，在英国已通过许可且 NICE 批准用于髋关节和膝关节置换术后。

应该在术前使用低分子量肝素。

应该在术后 6-8 小时或术后第二天给予磺达肝素。

达比加群应该在术后 1-4 小时开始使用。对于轻度肾损伤，年龄大于 75岁，或使用胺碘酮的患者，推荐减少药量方案。接受人工机械心脏瓣膜置换术的患者不推荐使用。

只要已止血，阿哌沙班应该在术后 12-24 小时开始使用。

只要已止血，利伐沙班应该在术后 6-10 小时开始使用。

华法林应该在术后给予。

剂量视适应症而定；向当地专科医生咨询治疗方案作为剂量指导。所有国家/地区都不推荐使用阿司匹林。

有高出血风险的患者应该在术前即开始接受机械性血栓预防，并持续到术后 10-35 天。[121]National Institute for Health and Care Excellence. Venous thromboembolism: reducing the risk for patients in hospital. Clinical guideline 92. June 2015. http://www.nice.org.uk/ (last accessed 26 October 2016).http://www.nice.org.uk/guidance/cg92/chapter/introduction[122]Falck-Ytter Y, Francis CW, Johanson NA, et al. Prevention of VTE in orthopedic surgery patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(suppl 2):e278S-325S.http://journal.publications.chestnet.org/article.aspx?articleid=1159591http://www.ncbi.nlm.nih.gov/pubmed/22315265?tool=bestpractice.com

如果长期使用，设备每天只能短时间取下（如当患者活动或洗澡时）。

如果出血的风险降低，应该考虑进行药物血栓预防。

接受髋部骨折手术的患者应在术后接受低分子量肝素、普通肝素或磺达肝素治疗长达 35 天。[121]National Institute for Health and Care Excellence. Venous thromboembolism: reducing the risk for patients in hospital. Clinical guideline 92. June 2015. http://www.nice.org.uk/ (last accessed 26 October 2016).http://www.nice.org.uk/guidance/cg92/chapter/introduction[122]Falck-Ytter Y, Francis CW, Johanson NA, et al. Prevention of VTE in orthopedic surgery patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(suppl 2):e278S-325S.http://journal.publications.chestnet.org/article.aspx?articleid=1159591http://www.ncbi.nlm.nih.gov/pubmed/22315265?tool=bestpractice.com

如果预期手术延迟，则低分子量肝素或普通肝素应在术前开始使用。

应该在术后 6-8 小时或术后第二天开始给予磺达肝素。

剂量视适应症而定；向当地专科医生咨询治疗方案作为剂量指导。

有高出血风险的患者应该在术前接受机械性血栓预防，并持续到术后 10-35 天。[122]Falck-Ytter Y, Francis CW, Johanson NA, et al. Prevention of VTE in orthopedic surgery patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(suppl 2):e278S-325S.http://journal.publications.chestnet.org/article.aspx?articleid=1159591http://www.ncbi.nlm.nih.gov/pubmed/22315265?tool=bestpractice.com

如果长期使用，设备每天只能短时间取下（如当患者活动或洗澡时）。

如果出血的风险降低，应该考虑进行药物血栓预防。

建议因脊髓损伤入院患者，在整个住院期间，以及如活动受限则在住院康复期间，接受低分子量肝素治疗。[120]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. Chest. 2012;141(suppl 2):e227S-277S.http://journal.publications.chestnet.org/article.aspx?articleid=1159472http://www.ncbi.nlm.nih.gov/pubmed/22315263?tool=bestpractice.com[121]National Institute for Health and Care Excellence. Venous thromboembolism: reducing the risk for patients in hospital. Clinical guideline 92. June 2015. http://www.nice.org.uk/ (last accessed 26 October 2016).http://www.nice.org.uk/guidance/cg92/chapter/introduction

剂量视适应症而定；向当地专科医生咨询治疗方案作为剂量指导。

具有高出血风险的患者在整个住院期间，以及如活动受限则在住院康复期间，应当接受机械性血栓预防。[120]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. Chest. 2012;141(suppl 2):e227S-277S.http://journal.publications.chestnet.org/article.aspx?articleid=1159472http://www.ncbi.nlm.nih.gov/pubmed/22315263?tool=bestpractice.com

如果长期使用，设备每天只能短时间取下（如当患者活动或洗澡时）。

如果出血的风险降低，应该考虑进行药物血栓预防。

建议因重大创伤入院患者，在整个住院期间，以及如活动受限则在住院康复期间，接受低分子量肝素治疗。[120]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. Chest. 2012;141(suppl 2):e227S-277S.http://journal.publications.chestnet.org/article.aspx?articleid=1159472http://www.ncbi.nlm.nih.gov/pubmed/22315263?tool=bestpractice.com[121]National Institute for Health and Care Excellence. Venous thromboembolism: reducing the risk for patients in hospital. Clinical guideline 92. June 2015. http://www.nice.org.uk/ (last accessed 26 October 2016).http://www.nice.org.uk/guidance/cg92/chapter/introduction

剂量视适应症而定；向当地专科医生咨询治疗方案作为剂量指导。

具有高出血风险的患者在整个住院期间，以及如活动受限则在住院康复期间，应当接受机械性血栓预防。[120]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. Chest. 2012;141(suppl 2):e227S-277S.http://journal.publications.chestnet.org/article.aspx?articleid=1159472http://www.ncbi.nlm.nih.gov/pubmed/22315263?tool=bestpractice.com

如果长期使用，设备每天只能短时间取下（如当患者活动或洗澡时）。

如果出血的风险降低，应该考虑进行药物血栓预防。

[54]Bates SM, Greer IA, Middeldorp S, et al. VTE, thrombophilia, antithrombotic therapy, and pregnancy. Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(2_suppl):e691S-e736S.http://journal.publications.chestnet.org/article.aspx?articleid=1159497http://www.ncbi.nlm.nih.gov/pubmed/22315276?tool=bestpractice.com建议对有其他遗传性易栓症的无症状孕妇进行个人风险评估，分娩前临床监测或药物血栓预防（低分子量肝素或普通肝素），以及产后 4-6 周的血栓预防。

剂量视适应症而定；向当地专科医生咨询治疗方案作为剂量指导。

[54]Bates SM, Greer IA, Middeldorp S, et al. VTE, thrombophilia, antithrombotic therapy, and pregnancy. Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(2_suppl):e691S-e736S.http://journal.publications.chestnet.org/article.aspx?articleid=1159497http://www.ncbi.nlm.nih.gov/pubmed/22315276?tool=bestpractice.com建议对有其他遗传性易栓症的无症状女性进行个人风险评估，分娩前临床监测或药物血栓预防（低分子量肝素或普通肝素），以及产后 4-6 周血栓预防。

剂量视适应症而定；向当地专科医生咨询治疗方案作为剂量指导。

对于抗磷脂综合征且有习惯性流产或妊娠晚期流产史，但之前无血栓静脉栓塞或动脉血栓的女性，整个妊娠期除阿司匹林外，推荐使用预防性 LMWH 或 UFH。[54]Bates SM, Greer IA, Middeldorp S, et al. VTE, thrombophilia, antithrombotic therapy, and pregnancy. Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(2_suppl):e691S-e736S.http://journal.publications.chestnet.org/article.aspx?articleid=1159497http://www.ncbi.nlm.nih.gov/pubmed/22315276?tool=bestpractice.com

剂量视适应症而定；向当地专科医生咨询治疗方案作为剂量指导。

剖宫产后考虑静脉血栓栓塞低风险的妇女，建议早期经常活动，无需血栓预防。

对于除了妊娠和剖宫产外还存在其他一项风险因素而使得剖宫产后静脉血栓栓塞风险升高的妇女，推荐分娩后住院期间进行药物血栓预防（低分子量肝素或普通肝素）或机械性血栓预防。[54]Bates SM, Greer IA, Middeldorp S, et al. VTE, thrombophilia, antithrombotic therapy, and pregnancy. Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(2_suppl):e691S-e736S.http://journal.publications.chestnet.org/article.aspx?articleid=1159497http://www.ncbi.nlm.nih.gov/pubmed/22315276?tool=bestpractice.com

剂量视适应症而定；向当地专科医生咨询治疗方案作为剂量指导。

对于需进行剖腹产且具有静脉血栓栓塞高风险的妇女，如合并多个额外的血栓栓塞风险因素，建议分娩后住院期间进行药物结合梯度压力袜和/或间歇充气加压疗法预防。[54]Bates SM, Greer IA, Middeldorp S, et al. VTE, thrombophilia, antithrombotic therapy, and pregnancy. Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(2_suppl):e691S-e736S.http://journal.publications.chestnet.org/article.aspx?articleid=1159497http://www.ncbi.nlm.nih.gov/pubmed/22315276?tool=bestpractice.com

剂量视适应症而定；向当地专科医生咨询治疗方案作为剂量指导。