venous%20thromboembolism%20-%20prevention
VENOUS THROMBOEMBOLISM - PREVENTION
Venous thromboembolism is comprised of pulmonary embolism and deep venous thrombosis and is associated with significant morbidity and mortality.
Decision on which type of prophylaxis to be given must be individualized for each patient.
All patients admitted for major trauma, surgery or acute medical illness should be assessed for risk of venous thromboembolism and bleeding before starting prophylaxis for venous thromboembolism.
Early mobilization and leg exercises for any patient recently immobilized are recommended. Immobilized patients should also be adequately hydrated.
Intermittent pneumatic compression devices periodically compress calf and/or thighs and stimulate fibrinolysis. It has been shown to be effective in prophylaxis of asymptomatic deep venous thrombosis in surgical patients.
Graduated compression stockings may be used for deep venous thrombosis prophylaxis in surgical patients with no contraindication for use.
  1. Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141(2)(Suppl):e419S-e494S. doi: 10.1378/chest.11-2301. PMID: 22315268
  2. Qaseem A, Chou R, Humphrey LL, et al. Venous thromboembolism prophylaxis in hospitalized patients: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2011 Nov;155(9):625-632. doi: 10.7326/0003-4819-155-9-201111010-00011. PMID: 22041951
  3. Hirsh J. Advances and contemporary issues in prophylaxis for deep vein thrombosis. Chest. 2003 Dec;124(6)(Suppl):347S-348S. PMID: 14668416
  4. Czyrny JJ, Kaplan RE, Wilding GE, et al. Electrical foot stimulation: a potential new method of deep venous thrombosis prophylaxis. Vascular. 2010 Jan;18(1):20-27. doi: 10.2310/6670.2010.00001. PMID: 20122356
  5. Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008 Jun;133(6)(Suppl):381S-453S. doi: 10.1378/chest.08-0656. PMID: 18574271
  6. Gross PL, Weitz JI. New anticoagulants for treatment of venous thromboembolism. Arterioscler Thromb Vasc Biol. 2008 Mar;28(3):380-386. doi: 10.1161/ATVBAHA.108.162677. PMID: 18296593
  7. Hirsh J, Bauer KA, Donati MB, et al. Parenteral anticoagulants: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008 Jun;133(6)(Suppl):141S-159S. doi: 10.1378/chest.08-0689. PMID: 18574264
  8. Kearon C. Duration of venous thromboembolism prophylaxis after surgery. Chest. 2003 Dec;124(6)(Suppl):386S-392S. PMID: 14668422
  9. Roderick P, Ferris G, Wilson K, et al. Towards evidence-based guidelines for the prevention of venous thromboembolism: systematic reviews of mechanical methods, oral anticoagulation, dextran and regional anaesthesia as thromboprophylaxis. Health Technol Assess. 2005 Dec;9(49):iii-iv, ix-x, 1-78. PMID: 16336844
  10. Weitz JI, Hirsh J, Samama MM. New antithrombotic drugs: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008 Jun;133(6)(Suppl):234S-256S. doi: 10.1378/chest.08-0673. PMID: 18574267
  11. MedWormhttp://www.medworm.com/rss/index.php/Cardiology/7/http://www.medworm.com/rss/medicalfeeds/specialities/Cardiology.xml
  12. Scottish Intercollegiate Guidelines Network. Prevention and management of venous thromboembolism: a national clinical guideline. SIGN. http://www.sign.ac.uk. Dec 2010. Accessed 16 Jan 2012.
  13. Australian Government. National Health and Medical Research Council. Clinical practice guideline for the prevention of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to Australian Hospitals. Draft for public consultation. http://www.nhmrc.gov.au. 2009.
  14. The Australian and New Zealand Working Party on the Management and Prevention of Venous Thromboembolism. Prevention of venous thromboembolism: best practice guideline for Australia & New Zealand. 4th Ed. http://www.surgeons.org/. 2007.
  15. National Institute for Health and Care Excellence. Rivaroxaban for the prevention of venous thromboembolism after total hip or total knee replacement in adults. NICE. http://www.nice.org.uk/. Apr 2009
  16. Ministry of Health, Academy of Medicine Malaysia, College of Surgeons Malaysia. Consensus on prophylaxis of venous thromboembolism. http://www.acadmed.org.my/. Jun 2000.
  17. Valentine KA, Hull RD. Therapeutic use of heparin and low molecular weight heparin. UpToDate. http://www.uptodate.com/. Dec 2011. Accessed 02 Feb 2012.
  18. Institute for Clinical Systems Improvement (ICSI). Venous thromboembolism prophylaxis. 8th ed. http://www.icsi.org. Jan 2012. Accessed 02 Feb 2012.
  19. National Collaborating Centre for Acute Care. Venous thromboembolism: reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in inpatients undergoing surgery. Methods, evidence & guidance. http://www.nice.org.uk/. Apr 2007.
  20. MedWorm - Thrombosishttp://www.medworm.com/rss/medicalfeeds/conditions/Thrombosis-News.xml
  21. Dupras D, Bluhm J, Felty C, et al. Institute for Clinical Systems Improvement (ICSI). Health care guideline: venous thromboembolism diagnosis and treatment. 13th ed. ICSI. https://www.icsi.org/. Jan 2013. Accessed 17 Jan 2014.
  22. American Academy of Orthopaedic Surgeons. Preventing venous thromboembolic disease in patients undergoing elective hip and knee arthroplasty. Evidence-based guideline and evidence report. American Academy of Orthopaedic Surgeons website. http://www.aaos.org/. Sep 2011. Accessed 23 Apr 2015.
  23. Jobin S, Kalliainen L, Adebayo L, et al. Institute for Clinical Systems Improvement. Venous thromboembolism prophylaxis. Institute for Clinical Systems Improvement website. https://www.icsi.org/. Nov 2012. Accessed 23 Apr 2015.
  24. Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease: CHEST Guideline and Expert Panel report. Chest. 2016 Feb;149(2):315-352. doi: 10.1016/j.chest.2015.11.026. PMID: 26867832
  25. Heidbuchel H, Verhamme P, Alings M, et al. Updated European Heart Rhythm Association practical guide on the use of non-vitamin K antagonist anticoagulants in patients with non-valvular atrial fibrillation. Europace. 2015 Oct;17(10):1467-1507. doi: 10.1093/europace/euv309. PMID: 26324838
  26. Zalpour A, Oo TH. Update on edoxaban for the prevention and treatment of thromboembolism: clinical applications based on current evidence. Adv Hematol. 2015;2015:920361. doi: 10.1155/2015/920361. PMID: 26351456
  27. Bauer KA. Risk and prevention of venous thromboembolism in adults with cancer. UpToDate. https://www.uptodate.com. 25 May 2016. Accessed 09 Sep 2016.
  28. National Clinical Guideline Centre - Acute and Chronic Conditions. Venous thromboembolism: reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism in patients admitted to hospital). Methods, evidence & guidance. National Institute for Health and Care Excellence (NICE). https://www.nice.org.uk. 2010.
  29. Bauer KA, Lip GYH. Overview of the causes of venous thrombosis. UpToDate website. www.uptodate.com/. Sep 2016.
  30. Benrashid E, Youngwirth LM, Turley RS, Mureebe L. Venous thromboembolism: prevention, diagnosis and treatment. In: Cameron JL. Current Surgical Therapy. 12th ed. Philadelphia, PA: Elsevier Inc; 2017:1091-1098.
  31. Liew NC, Chang YH, Choi G,et al; Asian Venous Thrombosis Forum. Asian venous thromboembolism guidelines: prevention of venous thromboembolism. Int Angiol. 2012 Dec;31(6):501-516. https://www.ncbi.nlm.nih.gov/pubmed/?term=23222928. PMID: 23222928
  32. Ministry of Health Malaysia. Clinical Practice Guidelines: Prevention and treatment of venous thromboembolism. Ministry of Health Malaysia website. http://www.moh.gov.my/. Aug 2013.
  33. Wilbur J, Shian B. Deep venous thrombosis and pulmonary embolism: current therapy. Am Fam Physician. 2017 Mar;95(5):295-302. http://www.aafp.org/. PMID: 28290648
  34. Wang KL, Yap ES, Goto S, et al. The diagnosis and treatment of venous thromboembolism in Asian patients. Thromb J. 2018;16(4). doi: 10.1186/s12959-017-0155-z. PMID: 29375274
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