Venous Thromboembolism: Prevention of Venous Thromboembolism in Surgical Hospitalized Patients
Publication Date: December 3, 2019
Recommendations
Mechanical vs pharmacological prophylaxis for patients undergoing major surgery
For patients undergoing major surgery, the ASH guideline panel suggests the following:
Using pharmacological prophylaxis or mechanical prophylaxis. (2, ⊕⊕oo)
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For patients who do not receive pharmacologic prophylaxis, using mechanical prophylaxis over no mechanical prophylaxis. (2, ⊕ooo)
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For patients who receive mechanical prophylaxis, using intermittent compression devices over graduated compression stockings. (2, ⊕ooo)
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For patients who receive pharmacologic prophylaxis, using combined prophylaxis with mechanical and pharmacological methods over prophylaxis with pharmacological agents alone. (2, ⊕ooo)
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Depending on the risk of VTE and bleeding based on the individual patient and the type of surgical procedure, using combined prophylaxis or mechanical prophylaxis alone. (2, ⊕⊕oo)
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Prophylactic insertion of an inferior vena cava filter
For patients undergoing major surgery, the ASH guideline panel suggests against using inferior vena cava (IVC) filters for prophylaxis of VTE. (2, ⊕ooo)
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Timing of antithrombotic prophylaxis
For patients undergoing major surgery, the ASH guideline panel suggests using extended antithrombotic prophylaxis over short-term antithrombotic prophylaxis. (2, ⊕ooo)
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The ASH guideline panel further suggests using early or delayed antithrombotic prophylaxis. (2, ⊕ooo)
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Orthopedic surgery
For patients undergoing total hip arthroplasty or total knee arthroplasty, the ASH guideline panel suggests using aspirin (ASA) or anticoagulants. (2, ⊕ooo)
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When anticoagulants are used, the panel suggests using direct oral anticoagulants (DOACs) over low-molecular-weight heparin (LMWH). (2, ⊕⊕⊕o)
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The panel suggests using any of the DOACs approved for use. (2, ⊕⊕oo)
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If a DOAC is not used, the panel suggests using LMWH rather than warfarin (2, ⊕ooo)
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and recommends LMWH rather than unfractionated heparin (UFH). (1, ⊕⊕⊕o)
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For patients undergoing hip fracture repair, the ASH guideline panel suggests using pharmacological prophylaxis over no pharmacological prophylaxis (2, ⊕ooo)
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and suggests using LMWH or UFH. (2, ⊕ooo)
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Major general surgery
For patients undergoing major general surgery, the ASH guideline panel suggests using pharmacological prophylaxis over no pharmacological prophylaxis (2, ⊕⊕oo)
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and suggests using LMWH or UFH. (2, ⊕ooo)
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Laparoscopic cholecystectomy
For patients undergoing laparoscopic cholecystectomy, the ASH guideline panel suggests against using pharmacological prophylaxis. (2, ⊕ooo)
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Major neurosurgical procedures
For patients undergoing major neurosurgical procedures, the ASH guideline panel suggests against using pharmacological prophylaxis. (2, ⊕ooo)
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For the subset of patients undergoing major neurosurgical procedures for whom pharmacological prophylaxis is used, the ASH guideline panel suggests using LMWH over UFH. (2, ⊕ooo)
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Urological procedures
For patients undergoing transurethral resection of the prostate (TURP), the ASH guideline panel suggests against using pharmacological prophylaxis. (2, ⊕ooo)
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For the subset of patients undergoing TURP for whom pharmacological prophylaxis is used, the ASH guideline panel suggests using LMWH or UFH. (2, ⊕ooo)
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For patients undergoing radical prostatectomy, the ASH guideline panel suggests against using pharmacological prophylaxis. (2, ⊕ooo)
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For patients undergoing radical prostatectomy in whom pharmacological prophylaxis is used, the ASH guideline panel suggests using LMWH or UFH. (2, ⊕ooo)
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Cardiac or major vascular surgery
For patients undergoing cardiac or major vascular surgery, the ASH guideline panel suggests using pharmacological prophylaxis or no pharmacological prophylaxis. (2⊕ooo)
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When pharmacological prophylaxis is used, the panel suggests using LMWH or UFH. (2⊕ooo)
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Major trauma
For patients experiencing major trauma and who are at low to moderate risk for bleeding, the ASH guideline panel suggests using pharmacological prophylaxis over no pharmacological prophylaxis. (2, ⊕ooo)
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For patients experiencing major trauma and who are at high risk for bleeding, the ASH guideline panel suggests against pharmacological prophylaxis. (2, ⊕ooo)
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For patients experiencing major trauma in whom pharmacological prophylaxis is used, the ASH guideline panel suggests using LMWH or UFH. (2, ⊕⊕oo)
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Major gynecological surgery
For patients undergoing major gynecological surgery, the ASH guideline panel suggests using pharmacological prophylaxis over no pharmacological prophylaxis (2, ⊕ooo)
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and suggests using LMWH or UFH. (2, ⊕ooo)
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Recommendation Grading
Disclaimer
Overview
Title
Venous Thromboembolism: Prevention of Venous Thromboembolism in Surgical Hospitalized Patients
Authoring Organization
American Society of Hematology
Publication Month/Year
December 3, 2019
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Document Objectives
These evidence-based guidelines from the American Society of Hematology (ASH) intend to support decision making about preventing VTE in patients undergoing surgery.
Target Patient Population
Patients undergoing major surgery
Inclusion Criteria
Female, Male, Adolescent, Adult, Older adult
Health Care Settings
Hospital
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Prevention
Diseases/Conditions (MeSH)
D054556 - Venous Thromboembolism, D020246 - Venous Thrombosis, D013502 - General Surgery
Keywords
prevention, anticoagulation, Venous Thromboembolism, Anticoagulation
Source Citation
Blood Adv (2019) 3 (23): 3898–3944.
Methodology
Number of Source Documents
417
Literature Search Start Date
November 1, 2016
Literature Search End Date
July 1, 2019