妊娠期和产褥期相关静脉血栓栓塞症防治指南及共识质量评价和内容比较

Quality assessment and contents comparison of guidelines and consensus for prophylaxis and treatment of pregnancy and puerperium-associated VTE

目的 对已发表的妊娠期及产褥期相关静脉血栓栓塞症(VTE)预防或治疗的国内外临床实践指南或专家共识进行质量评价,以期为中国产科VTE防治提供参考和依据。方法 系统检索建库至2021年10月国内外公开发表的、专门针对妊娠期及产褥期VTE防治的指南及共识。由2名研究人员独立筛选文献和提取资料,采用开发指南研究和评估工具Ⅱ(AGREEⅡ)及国际实践指南报告标准(RIGHT)对纳入的文献进行质量评价。结果共纳入指南和共识15篇。AGREEⅡ评价结果显示,严谨性(59.30%)和应用性(58.19%)方面的平均得分较低,5篇推荐等级为A级,10篇为B级;RIGHT评价结果显示,报告水平良好的指南及共识为5篇,报告水平中等的指南及共识为10篇,评审和质量保证(33.33%)及资金资助和利益冲突(45.00%)领域报告较差。其中中国共识综合质量上还有一定不足(AGREEⅡ:B;RIGHT:中等)。各指南及共识的推荐内容略有不同。结论 中国共识在背景、证据、评审、质控、资金、利益冲突声明和管理等领域仍需进一步提升,应开展更高循证级别的研究并严格按照AGREEⅡ及RIGHT制订指南或共识。

Objective To evaluate the quality of published clinical practice guidelines or expert consensus on the prevention and treatment of pregnancy-and puerperium-related venous thromboembolism(VTE)at home and abroad,so as to provide reference and guidance for the prevention and treatment of obstetric VTE in China.Methods The guidelines and consensus on the prevention and treatment of VTE during pregnancy and puerperium published at home and abroad from the establishment of the database to October 2021 were systematically searched. Two researchers independently screened the literature and extracted data,and evaluated the quality of the included guidelines by using the AGREEⅡ and RIGHT.Results A total of 15 guidelines and consensus were included. "Preciseness"(59.30%)and "Applicability"(58.19%)of AGREEⅡ scored lower than other domains. Among all the guidelines and consensus,5 were with a recommendation level of "A",10 with a rating of "B", "Review and quality assurance"(33.33%)and "Funding,declaration,and conflict of interests"(45.00%)of RIGHT were reported poorer than others,there were 5 guidelines with a good level,and another 10 were with a moderate level. There were still some deficiencies in the comprehensive quality of China’s consensus(AGREE Ⅱ: B;RIGHT: moderate level). The recommended contents of each guideline or consensus were slightly different.Conclusion Chinese consensus still needs to be further improved in the fields of background,evidence,review,quality control,funding,conflict of interest statement and management. We should carry out higher evidence-based research and formulate guidelines or consensus in strict accordance with AGREEⅡ and RIGHT.