Expert consensus on clinical application of parenteral direct thrombin inhibitors in perioperative period

JIANG Mingyu; BIAN Yuan; HAN Lizhu; YIN Qinan; KANG Fengjiao; WEI Anhua; ZHAO Danjie; WANG Lin; SHAO Ying; TANG Li; WANG Yi; LIANG Shuhong; LIU Huijuan; XIAO Guirong; LI Yue

doi:10.6039/j.issn.1001-0408.2026.06.01

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Expert consensus on clinical application of parenteral direct thrombin inhibitors in perioperative period

更新时间：2026-03-26

- Expert consensus on clinical application of parenteral direct thrombin inhibitors in perioperative period
- ZHONGGUO YAOFANG Vol. 37, Issue 6, Pages: 689-699(2026)
- 作者机构：
  
  1.四川省医学科学院·四川省人民医院（电子科技大学附属医院）药学部/个体化药物研究与治疗四川省重点实验室，成都;610072
  2.川北医学院药学院，四川南充　637000
  3.电子科技大学医学院，成都　610054
  4.新疆医科大学附属中医医院药学部，乌鲁木齐　830054
  5.华中科技大学同济医学院附属同济医院药学部，武汉　430033
  6.成都市双流区第一人民医院（四川大学华西空港医院）药学部，成都　610200
  7.成都市第七人民医院药剂科，成都　610041
  8.成都医学院第一附属医院药学部，成都　610500
  9.四川省第四人民医院药学部，成都　610066
  10.四川省第五人民医院药剂科，成都　611130
  11.郑州大学第一附属医院药学部，郑州　450052
  12.三六三医院药剂科，成都　610097
  13.四川大学华西医院药剂科，成都　610041
  14.四川大学华西天府医院药剂科，成都　610213
- 作者简介：
- 基金信息：
- DOI：10.6039/j.issn.1001-0408.2026.06.01
  CLC： R973+.2
- Received：10 November 2025，
  
  Revised：2026-03-05，
  
  Accepted：06 March 2026，
  
  Published：30 March 2026
- 稿件说明：
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蒋明玉,边原,韩丽珠,等.围手术期应用胃肠外直接凝血酶抑制剂的专家共识 [J].中国药房,2026,37(06):689-699.

JIANG Mingyu,BIAN Yuan,HAN Lizhu,et al.Expert consensus on clinical application of parenteral direct thrombin inhibitors in perioperative period[J].ZHONGGUO YAOFANG,2026,37(06):689-699.
蒋明玉,边原,韩丽珠,等.围手术期应用胃肠外直接凝血酶抑制剂的专家共识 [J].中国药房,2026,37(06):689-699. DOI： 10.6039/j.issn.1001-0408.2026.06.01.

JIANG Mingyu,BIAN Yuan,HAN Lizhu,et al.Expert consensus on clinical application of parenteral direct thrombin inhibitors in perioperative period[J].ZHONGGUO YAOFANG,2026,37(06):689-699. DOI： 10.6039/j.issn.1001-0408.2026.06.01.

摘要

目的

针对围手术期患者应用胃肠外直接凝血酶抑制剂（DTIs）的临床问题，形成专家共识。

方法

由四川省医学科学院·四川省人民医院（电子科技大学附属医院）牵头，组建多学科专家共识制订工作组。通过文献调研和德尔菲法遴选围手术期胃肠外DTIs合理使用的相关临床问题，采用“人群-干预-对比-结局”框架进行结构化设计；系统检索中国知网、Medline、Embase等数据库，纳入随机对照试验、队列研究等相关证据并进行整合；依据推荐意见分级的评估、制订及评价（GRADE）系统评估证据质量，通过多轮德尔菲调研及专家共识会议形成推荐意见。结果与

结论

共形成围手术期患者应用胃肠外DTIs的7条推荐意见（专家共识率均超过90%），明确了胃肠外DTIs用于心室辅助装置植入术围手术期、心脏手术围手术期、下肢动脉粥样硬化性疾病患者围手术期、急性冠脉综合征患者经皮冠脉介入术围手术期、颈动脉狭窄患者颈动脉支架植入术围手术期、右心血栓患者围手术期、置入中心静脉导管后发生相关血栓及功能障碍患者的药物选择、剂量范围、监测要点及安全管理策略，并提出围手术期出血/血栓事件的预警与处置流程。本共识基于现有最佳证据制定，可为围手术期胃肠外DTIs的规范化、个体化应用提供循证指导。

Abstract

OBJECTIVE

To form an expert consensus on the clinical application of parenteral direct thrombin inhibitors （DTIs） in patients during the perioperative period.

METHODS

Led by Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital （the Affiliated Hospital of UESTC）， a multidisciplinary working group was established. Through literature review and the Delphi method， clinical questions related to the rational perioperative use of parenteral DTIs were identified. A structured design was adopted using the “Population-Intervention-Comparison-Outcome” framework； systematic searches were conducted in CNKI， Medline， Embase and other databases. Relevant evidence from randomized controlled trials and cohort studies was included and synthesized. Evidence quality was assessed using the Grades of Recommendations Assessment，Development and Evaluation （GRADE） approach， and recommendations were formulated through multiple rounds of Delphi surveys and expert consensus meetings. RESULTS &

CONCLUSIONS

Seven recommendations （each with an expert consensus rate exceeding 90%） on the use of parenteral DTIs in perioperative patients were developed. These recommendations specify drug selection， dosing ranges， key monitoring points， and safety management strategies for parenteral DTIs in various scenarios， including the perioperative period of ventricular assist device implantation， the perioperative period of cardiac surgery， perioperative patients with lower-extremity atherosclerotic disease， the perioperative period of percutaneous coronary intervention in patients with acute coronary syndrome， the perioperative period of carotid artery stenting in patients with carotid stenosis， the perioperative period of patients with right heart thrombosis， and patients who develop related thrombosis and dysfunction after a central venous catheter insertion. In addition， warning and management pathways for perioperative bleeding and thrombotic events were proposed. This expert consensus， which is formulated based on the best available evidence， provides evidence-based guidance for standardized and individualized use of parenteral DTIs in perioperative period.

关键词

Keywords

references

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