Prevention of VTE in nonsurgical patients. Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines

Susan R. Kahn, Wendy Lim, Andrew S. Dunn, Mary Cushman, Francesco Dentali, Elie A. Akl, Deborah J. Cook, Alex A. Balekian, Russell C. Klein, Hoang Le, Sam Schulman, Mohammad H Murad

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Abstract

Background: This guideline addressed VTE prevention in hospitalized medical patients, outpatients with cancer, the chronically immobilized, long-distance travelers, and those with asymptomatic thrombophilia. Methods: This guideline follows methods described in Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines in this supplement. Results: For acutely ill hospitalized medical patients at increased risk of thrombosis, we recommend anticoagulant thromboprophylaxis with low-molecular-weight heparin (LMWH), low-dose unfractionated heparin (LDUH) bid, LDUH tid, or fondaparinux (Grade 1B) and suggest against extending the duration of thromboprophylaxis beyond the period of patient immobilization or acute hospital stay (Grade 2B). For acutely ill hospitalized medical patients at low risk of thrombosis, we recommend against the use of pharmacologic prophylaxis or mechanical prophylaxis (Grade 1B). For acutely ill hospitalized medical patients at increased risk of thrombosis who are bleeding or are at high risk for major bleeding, we suggest mechanical thromboprophylaxis with graduated compression stockings (GCS) (Grade 2C) or intermittent pneumatic compression (IPC) (Grade 2C). For critically ill patients, we suggest using LMWH or LDUH thromboprophylaxis (Grade 2C). For critically ill patients who are bleeding or are at high risk for major bleeding, we suggest mechanical thromboprophylaxis with GCS and/or IPC at least until the bleeding risk decreases (Grade 2C). In outpatients with cancer who have no additional risk factors for VTE we suggest against routine prophylaxis with LMWH or LDUH (Grade 2B) and recommend against the prophylactic use of vitamin K antagonists (Grade 1B). Conclusions: Decisions regarding prophylaxis in nonsurgical patients should be made after consideration of risk factors for both thrombosis and bleeding, clinical context, and patients' values and preferences.

Original languageEnglish (US)
JournalChest
Volume141
Issue number2 SUPPL.
DOIs
StatePublished - Feb 2012

Fingerprint

Evidence-Based Practice
Practice Guidelines
Thrombosis
Hemorrhage
Heparin
Low Molecular Weight Heparin
Compression Stockings
Guidelines
Therapeutics
Critical Illness
Outpatients
Thrombophilia
Vitamin K
Patient Preference
Immobilization
Anticoagulants
Length of Stay
Neoplasms

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Prevention of VTE in nonsurgical patients. Antithrombotic therapy and prevention of thrombosis, 9th ed : American College of Chest Physicians evidence-based clinical practice guidelines. / Kahn, Susan R.; Lim, Wendy; Dunn, Andrew S.; Cushman, Mary; Dentali, Francesco; Akl, Elie A.; Cook, Deborah J.; Balekian, Alex A.; Klein, Russell C.; Le, Hoang; Schulman, Sam; Murad, Mohammad H.

In: Chest, Vol. 141, No. 2 SUPPL., 02.2012.

Research output: Contribution to journalArticle

Kahn, Susan R. ; Lim, Wendy ; Dunn, Andrew S. ; Cushman, Mary ; Dentali, Francesco ; Akl, Elie A. ; Cook, Deborah J. ; Balekian, Alex A. ; Klein, Russell C. ; Le, Hoang ; Schulman, Sam ; Murad, Mohammad H. / Prevention of VTE in nonsurgical patients. Antithrombotic therapy and prevention of thrombosis, 9th ed : American College of Chest Physicians evidence-based clinical practice guidelines. In: Chest. 2012 ; Vol. 141, No. 2 SUPPL.
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abstract = "Background: This guideline addressed VTE prevention in hospitalized medical patients, outpatients with cancer, the chronically immobilized, long-distance travelers, and those with asymptomatic thrombophilia. Methods: This guideline follows methods described in Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines in this supplement. Results: For acutely ill hospitalized medical patients at increased risk of thrombosis, we recommend anticoagulant thromboprophylaxis with low-molecular-weight heparin (LMWH), low-dose unfractionated heparin (LDUH) bid, LDUH tid, or fondaparinux (Grade 1B) and suggest against extending the duration of thromboprophylaxis beyond the period of patient immobilization or acute hospital stay (Grade 2B). For acutely ill hospitalized medical patients at low risk of thrombosis, we recommend against the use of pharmacologic prophylaxis or mechanical prophylaxis (Grade 1B). For acutely ill hospitalized medical patients at increased risk of thrombosis who are bleeding or are at high risk for major bleeding, we suggest mechanical thromboprophylaxis with graduated compression stockings (GCS) (Grade 2C) or intermittent pneumatic compression (IPC) (Grade 2C). For critically ill patients, we suggest using LMWH or LDUH thromboprophylaxis (Grade 2C). For critically ill patients who are bleeding or are at high risk for major bleeding, we suggest mechanical thromboprophylaxis with GCS and/or IPC at least until the bleeding risk decreases (Grade 2C). In outpatients with cancer who have no additional risk factors for VTE we suggest against routine prophylaxis with LMWH or LDUH (Grade 2B) and recommend against the prophylactic use of vitamin K antagonists (Grade 1B). Conclusions: Decisions regarding prophylaxis in nonsurgical patients should be made after consideration of risk factors for both thrombosis and bleeding, clinical context, and patients' values and preferences.",
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AU - Dunn, Andrew S.

AU - Cushman, Mary

AU - Dentali, Francesco

AU - Akl, Elie A.

AU - Cook, Deborah J.

AU - Balekian, Alex A.

AU - Klein, Russell C.

AU - Le, Hoang

AU - Schulman, Sam

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