Venous Thromboembolism: Prevention of Venous Thromboembolism in Surgical Hospitalized Patients

Publication Date: December 3, 2019
Last Updated: March 14, 2022

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)
312101
For patients who do not receive pharmacologic prophylaxis, using mechanical prophylaxis over no mechanical prophylaxis. (2, ⊕ooo)
312101
For patients who receive mechanical prophylaxis, using intermittent compression devices over graduated compression stockings. (2, ⊕ooo)
312101
For patients who receive pharmacologic prophylaxis, using combined prophylaxis with mechanical and pharmacological methods over prophylaxis with pharmacological agents alone. (2, ⊕ooo)
312101
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)
312101

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)
312101

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)
312101
The ASH guideline panel further suggests using early or delayed antithrombotic prophylaxis. (2, ⊕ooo)
312101

Orthopedic surgery

For patients undergoing total hip arthroplasty or total knee arthroplasty, the ASH guideline panel suggests using aspirin (ASA) or anticoagulants. (2, ⊕ooo)
312101
When anticoagulants are used, the panel suggests using direct oral anticoagulants (DOACs) over low-molecular-weight heparin (LMWH). (2, ⊕⊕⊕o)
312101
The panel suggests using any of the DOACs approved for use. (2, ⊕⊕oo)
312101
If a DOAC is not used, the panel suggests using LMWH rather than warfarin (2, ⊕ooo)
312101
and recommends LMWH rather than unfractionated heparin (UFH). (1, ⊕⊕⊕o)
312101
For patients undergoing hip fracture repair, the ASH guideline panel suggests using pharmacological prophylaxis over no pharmacological prophylaxis (2, ⊕ooo)
312101
and suggests using LMWH or UFH. (2, ⊕ooo)
312101

Major general surgery

For patients undergoing major general surgery, the ASH guideline panel suggests using pharmacological prophylaxis over no pharmacological prophylaxis (2, ⊕⊕oo)
312101
and suggests using LMWH or UFH. (2, ⊕ooo)
312101

Laparoscopic cholecystectomy

For patients undergoing laparoscopic cholecystectomy, the ASH guideline panel suggests against using pharmacological prophylaxis. (2, ⊕ooo)
312101

Major neurosurgical procedures

For patients undergoing major neurosurgical procedures, the ASH guideline panel suggests against using pharmacological prophylaxis. (2, ⊕ooo)
312101
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)
312101

Urological procedures

For patients undergoing transurethral resection of the prostate (TURP), the ASH guideline panel suggests against using pharmacological prophylaxis. (2, ⊕ooo)
312101
For the subset of patients undergoing TURP for whom pharmacological prophylaxis is used, the ASH guideline panel suggests using LMWH or UFH. (2, ⊕ooo)
312101
For patients undergoing radical prostatectomy, the ASH guideline panel suggests against using pharmacological prophylaxis. (2, ⊕ooo)
312101
For patients undergoing radical prostatectomy in whom pharmacological prophylaxis is used, the ASH guideline panel suggests using LMWH or UFH. (2, ⊕ooo)
312101

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)
312101
When pharmacological prophylaxis is used, the panel suggests using LMWH or UFH. (2⊕ooo)
312101

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)
312101
For patients experiencing major trauma and who are at high risk for bleeding, the ASH guideline panel suggests against pharmacological prophylaxis. (2, ⊕ooo)
312101
For patients experiencing major trauma in whom pharmacological prophylaxis is used, the ASH guideline panel suggests using LMWH or UFH. (2, ⊕⊕oo)
312101

Major gynecological surgery

For patients undergoing major gynecological surgery, the ASH guideline panel suggests using pharmacological prophylaxis over no pharmacological prophylaxis (2, ⊕ooo)
312101
and suggests using LMWH or UFH. (2, ⊕ooo)
312101

Recommendation Grading

Disclaimer

Overview

Title

Venous Thromboembolism: Prevention of Venous Thromboembolism in Surgical Hospitalized Patients

Authoring Organization

Publication Month/Year

December 3, 2019

Last Updated Month/Year

July 28, 2023

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