| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
Guest Access | Sign In via User Name/Password
|
|
|
|||||||
Guest Access | Sign In via User Name/Password |
|||||||||
Correspondence to: William H. Geerts, MD, Thromboembolism Program, Sunnybrook & Women’s College Health Sciences Centre, Room D674, 2075 Bayview Ave, Toronto, ON, Canada M4N 3M5
This article discusses the prevention of venous thromboembolism (VTE) and is part of the Seventh American College of Chest Physicians Conference on Antithrombotic and Thrombolytic Therapy: Evidence-Based Guidelines. Grade 1 recommendations are strong and indicate that the benefits do, or do not, outweigh risks, burden, and costs. Grade 2 suggests that individual patients’ values may lead to different choices (for a full understanding of the grading see Guyatt et al, CHEST 2004; 126:179S–187S). Among the key recommendations in this chapter are the following. We recommend against the use of aspirin alone as thromboprophylaxis for any patient group (Grade 1A). For moderate-risk general surgery patients, we recommend prophylaxis with low-dose unfractionated heparin (LDUH) (5,000 U bid) or low-molecular-weight heparin (LMWH) [
3,400 U once daily] (both Grade 1A). For higher risk general surgery patients, we recommend thromboprophylaxis with LDUH (5,000 U tid) or LMWH (> 3,400 U daily) [both Grade 1A]. For high-risk general surgery patients with multiple risk factors, we recommend combining pharmacologic methods (LDUH three times daily or LMWH, > 3,400 U daily) with the use of graduated compression stockings and/or intermittent pneumatic compression devices (Grade 1C+). We recommend that thromboprophylaxis be used in all patients undergoing major gynecologic surgery (Grade 1A) or major, open urologic procedures, and we recommend prophylaxis with LDUH two times or three times daily (Grade 1A). For patients undergoing elective total hip or knee arthroplasty, we recommend one of the following three anticoagulant agents: LMWH, fondaparinux, or adjusted-dose vitamin K antagonist (VKA) [international normalized ratio (INR) target, 2.5; range, 2.0 to 3.0] (all Grade 1A). For patients undergoing hip fracture surgery (HFS), we recommend the routine use of fondaparinux (Grade 1A), LMWH (Grade 1C+), VKA (target INR, 2.5; range, 2.0 to 3.0) [Grade 2B], or LDUH (Grade 1B). We recommend that patients undergoing hip or knee arthroplasty, or HFS receive thromboprophylaxis for at least 10 days (Grade 1A). We recommend that all trauma patients with at least one risk factor for VTE receive thromboprophylaxis (Grade 1A). In acutely ill medical patients who have been admitted to the hospital with congestive heart failure or severe respiratory disease, or who are confined to bed and have one or more additional risk factors, we recommend prophylaxis with LDUH (Grade 1A) or LMWH (Grade 1A). We recommend, on admission to the intensive care unit, all patients be assessed for their risk of VTE. Accordingly, most patients should receive thromboprophylaxis (Grade 1A).
Key Words: aspirin • deep-vein thrombosis • fondaparinux • heparin • low-molecular-weight heparin • prophylaxis • thromboembolism • warfarin
This article has been cited by other articles:
|
|
 |
|
  J. F. Collen, J. L. Jackson, A. F. Shorr, and L. K. Moores Prevention of Venous Thromboembolism in Neurosurgery: A Metaanalysis Chest, August 1, 2008; 134(2): 237 - 249. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. A. Spencer, J. M. Gore, D. Lessard, J. D. Douketis, C. Emery, and R. J. Goldberg Patient Outcomes After Deep Vein Thrombosis and Pulmonary Embolism: The Worcester Venous Thromboembolism Study Arch Intern Med, February 25, 2008; 168(4): 425 - 430. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. F. Shorr, W. L. Jackson, J. H. Sherner, and L. K. Moores Differences Between Low-Molecular-Weight and Unfractionated Heparin for Venous Thromboembolism Prevention Following Ischemic Stroke: A Metaanalysis Chest, January 1, 2008; 133(1): 149 - 155. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. D. Dorr, V. Gendelman, A. V. Maheshwari, M. Boutary, Z. Wan, and W. T. Long Multimodal Thromboprophylaxis for Total Hip and Knee Arthroplasty Based on Risk Assessment J. Bone Joint Surg. Am., December 1, 2007; 89(12): 2648 - 2657. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. F. Tapson, H. Decousus, M. Pini, B. H. Chong, J. B. Froehlich, M. Monreal, A. C. Spyropoulos, G. J. Merli, R. B. Zotz, J.-F. Bergmann, et al. Venous Thromboembolism Prophylaxis in Acutely Ill Hospitalized Medical Patients: Findings From the International Medical Prevention Registry on Venous Thromboembolism Chest, September 1, 2007; 132(3): 936 - 945. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. A. Yegen, D. J. Lederer, R. G. Barr, J. S. Wilt, Y. Fang, E. Bagiella, F. D'Ovidio, J. M. Okun, J. R. Sonett, S. M. Arcasoy, et al. Risk Factors for Venous Thromboembolism After Lung Transplantation Chest, August 1, 2007; 132(2): 547 - 553. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Piazza, A. Seddighzadeh, and S. Z. Goldhaber Double Trouble for 2,609 Hospitalized Medical Patients Who Developed Deep Vein Thrombosis: Prophylaxis Omitted More Often and Pulmonary Embolism More Frequent Chest, August 1, 2007; 132(2): 554 - 561. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Huerta, S. Johansson, M.-A. Wallander, and L. A. Garcia Rodriguez Risk Factors and Short-term Mortality of Venous Thromboembolism Diagnosed in the Primary Care Setting in the United Kingdom Arch Intern Med, May 14, 2007; 167(9): 935 - 943. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Dentali, J. D. Douketis, M. Gianni, W. Lim, and M. A. Crowther Meta-analysis: Anticoagulant Prophylaxis to Prevent Symptomatic Venous Thromboembolism in Hospitalized Medical Patients Ann Intern Med, February 20, 2007; 146(4): 278 - 288. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Z. Goldhaber and M. Berkwits Trials That Matter: Can Patients with Venous Thromboembolism Be Treated with Fixed-Dose Subcutaneous Unfractionated Heparin? Ann Intern Med, December 19, 2006; 145(12): 929 - 931. [Full Text] [PDF]
|
|
|
|
 |
|
 H. Khouli, J. Shapiro, V. P. Pham, A. Arfaei, O. Esan, R. Jean, and P. Homel Efficacy of Deep Venous Thrombosis Prophylaxis in the Medical Intensive Care Unit J Intensive Care Med, December 1, 2006; 21(6): 352 - 358. [Abstract] [PDF]
|
|
|
|
 |
|
 C. C. Buckenmaier III, C. H. Shields, A. A. Auton, S. L. Evans, S. M. Croll, L. L. Bleckner, D. S. Brown, and A. Stojadinovic Continuous peripheral nerve block in combat casualties receiving low-molecular weight heparin Br. J. Anaesth., December 1, 2006; 97(6): 874 - 877. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Sellier, J. Labarere, J.-L. Bosson, M. Auvray, M.-T. Barrellier, C. Le Hello, J. Belmin, P. Le Roux, M.-A. Sevestre, and for the Association pour la Promotion de l'Angiolo Effectiveness of a guideline for venous thromboembolism prophylaxis in elderly post-acute care patients: a multicenter study with systematic ultrasonographic examination. Arch Intern Med, October 23, 2006; 166(19): 2065 - 2071. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. C. Spyropoulos Introduction. Am. J. Health Syst. Pharm., October 15, 2006; 63(20 Suppl 6): S3 - S4. [Full Text] [PDF]
|
|
|
|
|
|
D. A. MacDougall, A. L. Feliu, S. J. Boccuzzi, and J. Lin Economic burden of deep-vein thrombosis, pulmonary embolism, and post-thrombotic syndrome. Am. J. Health Syst. Pharm., October 15, 2006; 63(20 Suppl 6): S5 - S15. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Edelsberg, M. Hagiwara, C. Taneja, and G. Oster Risk of venous thromboembolism among hospitalized medically ill patients. Am. J. Health Syst. Pharm., October 15, 2006; 63(20 Suppl 6): S16 - S22. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Burleigh, C. Wang, D. Foster, S. Heller, D. Dunn, K. Safavi, B. Griffin, and J. Smith Thromboprophylaxis in medically ill patients at risk for venous thromboembolism. Am. J. Health Syst. Pharm., October 15, 2006; 63(20 Suppl 6): S23 - S29. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Gaitini, N. Beck-Razi, N. Haim, and B. Brenner Prevalence of Upper Extremity Deep Venous Thrombosis Diagnosed by Color Doppler Duplex Sonography in Cancer Patients With Central Venous Catheters. J. Ultrasound Med., October 1, 2006; 25(10): 1297 - 1303. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. K. Henke, C. G. Pearce, D. M. Moaveni, A. J. Moore, E. M. Lynch, C. Longo, M. Varma, N. A. Dewyer, K. B. Deatrick, G. R. Upchurch Jr, et al. Targeted Deletion of CCR2 Impairs Deep Vein Thombosis Resolution in a Mouse Model. J. Immunol., September 1, 2006; 177(5): 3388 - 3397. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. J. Leonardi, M. L. McGory, and C. Y. Ko The Rate of Bleeding Complications After Pharmacologic Deep Venous Thrombosis Prophylaxis: A Systematic Review of 33 Randomized Controlled Trials Arch Surg, August 1, 2006; 141(8): 790 - 799. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. J. Steier, G. Singh, A. Ullah, J. Maneja, R. S. Ha, and F. Khan Venous thromboembolism: application and effectiveness of the american college of chest physicians 2001 guidelines for prophylaxis. J Am Osteopath Assoc, July 1, 2006; 106(7): 388 - 395. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. Izrailtyan, J. Clark, M. Swaminathan, M. V. Podgoreanu, B. Mackensen, R. D. Davis, and J. P. Mathew Case report: Optimizing intraoperative detection of pulmonary embolism using contrast-enhanced echocardiography: [Presentation de cas : optimaliser la detection peroperatoire de l'embolie pulmonaire au moyen de l'echocardiographie de contraste]. Can J Anesth, July 1, 2006; 53(7): 711 - 715. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Motte, C. M. Samama, J. Guay, J. Barre, J.-Y. Borg, and N. Rosencher Prevention of postoperative venous thromboembolism. Risk assessment and methods of prophylaxis: [La prevention de la thromboembolie veineuse postoperatoire. Evaluation du risque et methodes de prophylaxie] Can J Anesth, June 1, 2006; 53(6_suppl): S68 - S79. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. W. Colwell Jr., S. D. Berkowitz, J. R. Lieberman, P. C. Comp, J. S. Ginsberg, G. Paiement, J. McElhattan, A. W. Roth, and C. W. Francis J. Bone Joint Surg. Am., May 1, 2006; 88(5): 1163 - 1165. [Full Text] [PDF]
|
|
|
|
|
|
Correction: Trends in the Incidence of Venous Thromboembolism during Pregnancy or Postpartum: A 30-Year Population-Based Study Ann Intern Med, March 21, 2006; 144(6): 460 - 460. [Full Text] [PDF]
|
|
|
|
 |
|
 S I R Noble, A Nelson, C Turner, and I G Finlay Acceptability of low molecular weight heparin thromboprophylaxis for inpatients receiving palliative care: qualitative study BMJ, March 11, 2006; 332(7541): 577 - 580. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. J. Comerota Retrievable IVC Filters: A Decision Matrix for Appropriate Utilization Perspectives in Vascular Surgery and Endovascular Therapy, March 1, 2006; 18(1): 11 - 17. [Abstract] [PDF]
|
|
|
|
 |
|
 Thromboembolism after pneumonectomy for malignancy: An independent marker of poor outcome. J. Thorac. Cardiovasc. Surg., March 1, 2006; 131(3): 711 - 718.
|
|
|
|
 |
|
 N Wiles and B J Hunt Anticoagulation via anti-Factor Xa inhibition Lupus, March 1, 2006; 15(3): 167 - 171. [Abstract] [PDF]
|
|
|
|
|
|
A. K. Lilikakis, T. Papapolychroniou, G. Macheras, and E. Michelinakis Thrombocytopenia and Intra-cerebral Complications Associated with Low-Molecular-Weight Heparin Treatment in Patients Undergoing Total Hip Replacement. A Report of Two Cases J. Bone Joint Surg. Am., March 1, 2006; 88(3): 634 - 638. [Full Text] [PDF]
|
|
|
|
 |
|
 M. A. Martino, E. Borges, E. Williamson, S. Siegfried, A. B. Cantor, J. Lancaster, W. S. Roberts, and M. S. Hoffman Pulmonary Embolism After Major Abdominal Surgery in Gynecologic Oncology. Obstet. Gynecol., March 1, 2006; 107(3): 666 - 671. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. P. Gelber and T. B. Seto Patient ethnicity and use of venous thromboembolism prophylaxis Int. J. Qual. Health Care, February 1, 2006; 18(1): 23 - 29. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Kroger, D. Weiland, C. Ose, N. Neumann, S. Weiss, C. Hirsch, K. Urbanski, S. Seeber, and M. E. Scheulen Risk factors for venous thromboembolic events in cancer patients Ann. Onc., February 1, 2006; 17(2): 297 - 303. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J.-L. Bosson and J. Labarere Determining indications for care common to competing guidelines by using classification tree analysis: application to the prevention of venous thromboembolism in medical inpatients. Med Decis Making, January 1, 2006; 26(1): 63 - 75. [Abstract] [PDF]
|
|
|
|
 |
|
 F. A. Anderson Jr, M. Zayaruzny, J. A. Heit, A. T. Cohen, and On Behalf of the VTE Impact Assessment Group Estimated Annual Number of US Acute-Care Hospital Inpatients Meeting ACCP Criteria for Venous Thromboembolism (VTE) Prophylaxis. Blood (ASH Annual Meeting Abstracts), November 16, 2005; 106(11): 903 - 903. [Abstract]
|
|
|
|
|
|
S. D. Brouse Prevention of venous thromboembolism in the medically ill Am. J. Health Syst. Pharm., November 15, 2005; 62(22): 2338 - 2342. [Full Text] [PDF]
|
|
|
|
|
|
J. A. Heit, C. E. Kobbervig, A. H. James, T. M. Petterson, K. R. Bailey, and L. J. Melton III Trends in the Incidence of Venous Thromboembolism during Pregnancy or Postpartum: A 30-Year Population-Based Study Ann Intern Med, November 15, 2005; 143(10): 697 - 706. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. A Spinler and R. J Friedman Comment: low-dose warfarin for prevention of symptomatic thromboembolism after orthopedic surgery Ann. Pharmacother., November 1, 2005; 39(11): 1954 - 1955. [Full Text] [PDF]
|
|
|
|
|
|
E. S. Darze, A. L. Latado, A. G. Guimaraes, R. A. V. Guedes, A. B. Santos, S. S. de Moura, and L. C. S. Passos Incidence and Clinical Predictors of Pulmonary Embolism in Severe Heart Failure Patients Admitted to a Coronary Care Unit Chest, October 1, 2005; 128(4): 2576 - 2580. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Lacut, L. Bressollette, G. Le Gal, E. Etienne, A. De Tinteniac, A. Renault, F. Rouhart, G. Besson, J. -F. Garcia, D. Mottier, et al. Prevention of venous thrombosis in patients with acute intracerebral hemorrhage Neurology, September 27, 2005; 65(6): 865 - 869. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Di Nisio, S. Middeldorp, and H. R. Buller Direct Thrombin Inhibitors N. Engl. J. Med., September 8, 2005; 353(10): 1028 - 1040. [Full Text] [PDF]
|
|
|
|
|
|
California Acute Stroke Pilot Registry (CASPR) Inv The impact of standardized stroke orders on adherence to best practices Neurology, August 9, 2005; 65(3): 360 - 365. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. C. Spyropoulos Emerging Strategies in the Prevention of Venous Thromboembolism in Hospitalized Medical Patients Chest, August 1, 2005; 128(2): 958 - 969. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. F. Tapson, T. M. Hyers, A. L. Waldo, D. J. Ballard, R. C. Becker, J. A. Caprini, R. Khetan, A. K. Wittkowsky, K. J. Colgan, A. C. Shillington, et al. Antithrombotic Therapy Practices in US Hospitals in an Era of Practice Guidelines Arch Intern Med, July 11, 2005; 165(13): 1458 - 1464. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Archibeck and R. E. White Jr. What's New in Adult Reconstructive Knee Surgery J. Bone Joint Surg. Am., July 1, 2005; 87(7): 1656 - 1666. [Full Text] [PDF]
|
|
|
|
|
|
D. F Brophy, J. A Dougherty, J. C Garrelts, R. C Parish, M. P Rivey, J. L Stumpf, C. T Taylor, and A S. Mathis Venous Thromboembolism Prevention in Acutely Ill Nonsurgical Patients Ann. Pharmacother., July 1, 2005; 39(7): 1318 - 1324. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. T. Horlocker and D. R. Brown Evidence-Based Medicine: Haute Couture or the Emperor's New Clothes? Anesth. Analg., June 1, 2005; 100(6): 1807 - 1810. [Full Text] [PDF]
|
|
|
|
|
|
J. J Enyart and R. J Jones Low-Dose Warfarin for Prevention of Symptomatic Thromboembolism After Orthopedic Surgery Ann. Pharmacother., June 1, 2005; 39(6): 1002 - 1007. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Falanga and L. Zacharski Deep vein thrombosis in cancer: the scale of the problem and approaches to management Ann. Onc., May 1, 2005; 16(5): 696 - 701. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Stangier, B. I. Eriksson, O. E. Dahl, L. Ahnfelt, G. Nehmiz, H. Stahle, K. Rathgen, and R. Svard Pharmacokinetic Profile of the Oral Direct Thrombin Inhibitor Dabigatran Etexilate in Healthy Volunteers and Patients Undergoing Total Hip Replacement J. Clin. Pharmacol., May 1, 2005; 45(5): 555 - 563. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. S. Lam and R. P Sims-McCallum Recombinant Factor VIIa in the Treatment of Non-Hemophiliac Bleeding Ann. Pharmacother., May 1, 2005; 39(5): 885 - 891. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. W Eikelboom Prophylactic use of LMWH plus intermittent pneumatic compression prevented DVT in hip or knee arthroplasty Evid. Based Med., April 1, 2005; 10(2): 48 - 48. [Full Text] [PDF]
|
|
|
|
 |
|
 S. Z. Goldhaber and A. G.G. Turpie Prevention of Venous Thromboembolism Among Hospitalized Medical Patients Circulation, January 4, 2005; 111(1): e1 - e3. [Full Text] [PDF]
|
|
|
|
 |
|
 A. G. G. Turpie, B. I. Eriksson, K. A. Bauer, and M. R. Lassen Fondaparinux J. Am. Acad. Ortho. Surg., November 1, 2004; 12(6): 371 - 375. [Full Text] [PDF]
|
|
|
|
|
|
G. Guyatt, D. Cook, and B. Haynes Evidence based medicine has come a long way BMJ, October 30, 2004; 329(7473): 990 - 991. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
