Prevention Of VTE In Nonorthopedic Surgical Patients
Publication Date: February 1, 2012
Recommendations
Risk Stratification, Rationale for Prophylaxis, and Recommendations in General, Abdominal-Pelvic, Bariatric, Vascular, and Plastic and Reconstructive Surgery
For general and abdominal-pelvic surgery patients at very low risk for VTE ( <0.5%; Rogers score, <7; Caprini score, 0), we recommend that
- no specific pharmacologic
(1, B)307795
prophylaxis be used other than early ambulation.
For general and abdominal-pelvic surgery patients at low risk for VTE (~1.5%; Rogers score, 7-10; Caprini score, 1-2), we suggest mechanical prophylaxis, preferably with IPC, over no prophylaxis. (2, C)
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For general and abdominal-pelvic surgery patients at moderate risk for VTE (~3.0%; Rogers score, >10; Caprini score, 3-4) who are not at high risk for major bleeding complications, we suggest
- or mechanical prophylaxis, preferably with IPC,
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over no prophylaxis.
For general and abdominal-pelvic surgery patients at moderate risk for VTE ( ~3.0%; Rogers score, >10; Caprini score, 3-4) who are at high risk for major bleeding complications or those in whom the consequences of bleeding are thought to be particularly severe, we suggest mechanical prophylaxis, preferably with IPC, over no prophylaxis. (2, C)
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For general and abdominal-pelvic surgery patients at high risk for VTE ( ~6.0%; Caprini score, ≥5) who are not at high risk for major bleeding complications, we recommend pharmacologic prophylaxis with
over no prophylaxis.
We suggest that mechanical prophylaxis with ES or IPC should be added to pharmacologic prophylaxis. (2, C)
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For high-VTE-risk patients undergoing abdominal or pelvic surgery for cancer who are not otherwise at high risk for major bleeding complications, we recommend extended-duration pharmacologic prophylaxis (4 weeks) with LMWH over limited-duration prophylaxis. (1, B)
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For high-VTE-risk general and abdominal-pelvic surgery patients who are at high risk for major bleeding complications or those in whom the consequences of bleeding are thought to be particularly severe, we suggest use of mechanical prophylaxis, preferably with IPC, over no prophylaxis until the risk of bleeding diminishes and pharmacologic prophylaxis may be initiated. (2, C)
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For general and abdominal-pelvic surgery patients at high risk for VTE ( ~6%; Caprini score, ≥5) in whom both LMWH and unfractionated heparin are contraindicated or unavailable and who are not at high risk for major bleeding complications, we suggest
- or mechanical prophylaxis, preferably with IPC,
(2, C)307795
over no prophylaxis.
For general and abdominal-pelvic surgery patients, we suggest that an IVC filter should not be used for primary VTE prevention. (2, C)
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For general and abdominal-pelvic surgery patients, we suggest that periodic surveillance with venous compression ultrasonography (VCU) should not be performed. (2, C)
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Target Population: Cardiac Surgery
For cardiac surgery patients with an uncomplicated postoperative course, we suggest use of mechanical prophylaxis, preferably with optimally applied IPC, over either.
- or pharmacologic prophylaxis.
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For cardiac surgery patients whose hospital course is prolonged by one or more nonhemorrhagic surgical complications, we suggest adding pharmacologic prophylaxis with LDUH or LMWH to mechanical prophylaxis. (2, C)
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Target Population: Thoracic Surgery
For thoracic surgery patients at moderate risk for VTE who are not at high risk for major bleeding, we suggest
- or mechanical prophylaxis with optimally applied IPC
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over no prophylaxis.
For thoracic surgery patients at high risk for VTE who are not at high risk for major bleeding, we suggest
over no prophylaxis.
In addition, we suggest that mechanical prophylaxis with ES or IPC should be added to pharmacologic prophylaxis. (2, C)
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For thoracic surgery patients who are at high risk for major bleeding, we suggest use of mechanical prophylaxis, preferably with optimally applied IPC, over no prophylaxis until the risk of bleeding diminishes and pharmacologic prophylaxis may be initiated. (2, C)
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Target Population: Craniotomy
For craniotomy patients, we suggest that mechanical prophylaxis, preferably with IPC, be used over
- or pharmacologic prophylaxis
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For craniotomy patients at very high risk for VTE (eg, those undergoing craniotomy for malignant disease), we suggest adding pharmacologic prophylaxis to mechanical prophylaxis once adequate hemostasis is established and the risk of bleeding decreases. (2, C)
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Target Population: Spinal Surgery
For patients undergoing spinal surgery, we suggest mechanical prophylaxis, preferably with IPC, over
For patients undergoing spinal surgery at high risk for VTE (including those with malignant disease and those undergoing surgery with a combined anterior-posterior approach), we\ suggest adding pharmacologic prophylaxis to mechanical prophylaxis once adequate hemostasis is established and the risk of bleeding decreases. (2, C)
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Target Population: Major Trauma, Including Traumatic Brain Injury, Acute Spinal Cord Injury, and Traumatic Spine Surgery
For major trauma patients, we suggest use of
- or mechanical prophylaxis, preferably with IPC.
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over no prophylaxis.
For major trauma patients at high risk for VTE (including those with acute spinal cord injury, traumatic brain injury, and spinal surgery for trauma), we suggest adding mechanical prophylaxis to pharmacologic prophylaxis (2, C)
when not contraindicated by lower-extremity injury.
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For major trauma patients in whom LMWH and LDUH are contraindicated, we suggest mechanical prophylaxis, preferably with IPC, over no prophylaxis (2, C)
when not contraindicated by lower-extremity injury.
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We suggest adding pharmacologic prophylaxis with either LMWH or LDUH when the risk of bleeding diminishes or the contraindication to heparin resolves. (2, C)
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For major trauma patients, we suggest that an IVC filter should not be used for primary VTE prevention. (2, C)
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For major trauma patients, we suggest that periodic surveillance with VCU should not be performed. (2, C)
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Title
Prevention Of VTE In Nonorthopedic Surgical Patients
Authoring Organization
American College of Chest Physicians
Publication Month/Year
February 1, 2012
External Publication Status
Published
Country of Publication
US
Document Objectives
We developed recommendations for thromboprophylaxis in nonorthopedic surgical patients
Target Patient Population
Patients requires non-orthopedic surgery
Inclusion Criteria
Female, Male, Adolescent, Adult, Older adult
Health Care Settings
Hospital, Operating and recovery room, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Prevention, Management, Treatment
Diseases/Conditions (MeSH)
D000925 - Anticoagulants, D013502 - General Surgery, D003107 - Colorectal Surgery, D013903 - Thoracic Surgery, D013518 - Surgery, Plastic, D000079645 - Perioperative Medicine, D011315 - Preventive Medicine, D019990 - Perioperative Care, D059035 - Perioperative Period
Keywords
anticoagulation, surgery, antiplatelet agents, perioperative care, Antithrombotic Agents, Anticoagulation
Methodology
Number of Source Documents
199
Literature Search Start Date
January 1, 2005
Literature Search End Date
December 31, 2010