脓毒症抗凝治疗策略应用现状：一项多中心横断面调查

王思佳; 薛明明; 宋振举; 沈佳圆; 孙健; 陈少叠; 邵勉

doi:10.12025/j.issn.1008-6358.2023.20230492

脓毒症抗凝治疗策略应用现状：一项多中心横断面调查

Application status of anticoagulant strategies for sepsis patients among the physicians: a multicenter cross-sectional questionnaire-based study

摘要

摘要:
目的了解国内临床医师对脓毒症患者凝血功能的评估手段以及在不同情况下抗凝策略的选择。
方法由复旦大学附属中山医院急诊科通过“问卷星”设计问卷，自2022年7月30日至2022年9月4日通过微信、电子邮件等方式推送至国内多家急诊、重症医学中心参与脓毒症患者诊治的临床医师，回收答卷后进行分析。
结果回收问卷157份，其中约半数医师的医疗机构未开展特殊凝血标志物检测。对于脓毒症患者，临床医师较多选用低分子肝素抗凝(72.6%~80.9%)，并根据临床情况（如手术、发生弥散性血管内凝血、出血、术前口服抗凝药物等）进行调整。当发生或既往存在肝素诱导的血小板减少症（heparin-induced thrombocytopenia，HIT）Ⅱ型时，45.2%~61.1%的临床医师未选择非肝素类抗凝药物；对于术前服用华法林或直接口服抗凝药物（direct oral anticoagulant，DOAC）的术后患者，30.6%~45.2%的临床医师选择不抗凝或低分子肝素抗凝。
结论临床医师一般给予脓毒症患者抗凝治疗，应用最广泛的药物为低分子肝素。对于发生HIT的脓毒症患者，抗凝决策常不符合指南；对于术前服用口服抗凝药的围手术期患者，临床医师对抗凝治疗持谨慎态度。

Abstract:
Objective To survey the current status of anticoagulant therapy for sepsis among the physicians in China.
Methods This was a web-based, multicenter, cross-sectional questionnaire study, conducted over two months (July to September 2022). The questions were designed by sepsis workshop members in EICU of Zhongshan Hospital. The questionnaires were sent to and then collected from physicians who were involved in the care of ICU patients with sepsis nationwide from July to September in 2022.
Results The questionnaire results were collected and analyzed from 157 physicians from 157 centers. About half the ICUs only conducted classical coagulation laboratory tests. For the sepsis patients, The most physicians (72.6%-80.9%) preferred to choose the low molecular weight heparin (LMWH). When heparin-induced thrombocytopenia (HIT) Ⅱ occurred or had HIT Ⅱ past, most physicians (45.2%-61.1%) didn't choose to give non-heparin anticoagulants. For postoperative patients taking warfarin or direct oral anticoagulant (DOAC) preoperatively, most physicians (30.6%-45.2%) didn't choose anticoagulation or gave LMWH.
Conclusions Most physicians prefer anticoagulation treatment in patients with sepsis and LMWH is most widely used. For HIT, most physicians do not choose the strategy recommended by guidelines; for perioperative patients taking oral anticoagulants, more physicians hold a cautious attitude towards anticoagulation therapy.

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