Prevention Of VTE In Nonsurgical Patients
Publication Date: February 1, 2012
Recommendations
Hospitalized Acutely Ill Medical Patients
For acutely ill hospitalized medical patients at increased risk of thrombosis, we recommend anticoagulant thromboprophylaxis With LMWH, LDUH bid, LDUH tid, or fondaparinux. (1, B)
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For acutely ill hospitalized medical patients at low risk of thrombosis ( Table 2 ), we recommend against the use of pharmacologic prophylaxis or mechanical prophylaxis. (1, B)
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For acutely ill hospitalized medical patients who are bleeding or at high risk for bleeding, we recommend against anticoagulant thromboprophylaxis. (1, B)
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For acutely ill hospitalized medical patients at increased risk of thrombosis who are bleeding or at high risk for major bleeding, we suggest.
- the optimal use of mechanical thromboprophylaxis with graduated compression stockings (GCS)
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- or intermittent pneumatic compression (IPC),
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- rather than no mechanical thromboprophylaxis. When bleeding risk decreases, and if VTE risk persists, we suggest that pharmacologic thromboprophylaxis be substituted for mechanical thromboprophylaxis.
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In acutely ill hospitalized medical patients who receive an initial course of thromboprophylaxis, we suggest against extending the duration of thromboprophylaxis beyond the period of patient immobilization or acute hospital stay. (2, B)
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Critically Ill Patients
In critically ill patients, we suggest against routine ultrasound screening for DVT. (2, C)
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For critically ill patients, we suggest using LMWH or LDUH thromboprophylaxis over no prophylaxis. (2, C)
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For critically ill patients who are bleeding, or are at high risk for major bleeding,
- we suggest mechanical thromboprophylaxis with GCS
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- until the bleeding risk decreases, rather than no mechanical thromboprophylaxis. When bleeding risk decreases, we suggest that pharmacologic thromboprophylaxis be substituted for mechanical thromboprophylaxis.
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Patients With Cancer in the Outpatient Setting
In outpatients with cancer who have no additional risk factors for VTE, we suggest
- against routine prophylaxis with LMWH or LDUH
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- and recommend against the prophylactic use of VKAs.
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In outpatients with solid tumors who have additional risk factors for VTE and who are at low risk of bleeding, we suggest prophylacticdose LMWH or LDUH over no prophylaxis. (2, B)
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In outpatients with cancer and indwelling central venous catheters, (CVCs),
- we suggest against routine prophylaxis with LMWH or LDUH
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- and suggest against the prophylactic use of VKAs.
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Chronically Immobilized Outpatients
In chronically immobilized persons residing at home or at a nursing home, we suggest against the routine use of thromboprophylaxis. (2, C)
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Long-Distance Travel
For long-distance travelers at increased risk of VTE (including previous VTE, recent surgery or trauma, active malignancy, pregnancy, estrogen use, advanced age, limited mobility, severe obesity, or known thrombophilic disorder), we suggest frequent ambulation, calf muscle exercise or sitting in an aisle seat if feasible. (2, C)
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For long-distance travelers at increased risk of VTE (including previous VTE, recent surgery or trauma, active malignancy, pregnancy, estrogen use, advanced age, limited mobility, severe obesity, or known thrombophilic disorder), we suggest use of properly fi tted, below-knee GCS providing 15 to 30 mm Hg of pressure at the ankle stockings during travel. (2, C)
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For all other long-distance travelers, we suggest against the use of GCS. (2, C)
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For long-distance travelers, we suggest against the use of aspirin or anticoagulants to prevent VTE. (2, C)
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Thromboprophylaxis to Prevent VTE in Asymptomatic Persons With Thrombophilia
In persons with asymptomatic thrombophilia (ie, without a previous history of VTE), we recommend against the long-term daily use of mechanical or pharmacologic thromboprophylaxis to prevent VTE. (1, C)
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Title
Prevention Of VTE In Nonsurgical Patients
Authoring Organization
American College of Chest Physicians
Publication Month/Year
February 1, 2012
External Publication Status
Published
Country of Publication
US
Document Objectives
This guideline addressed VTE prevention in hospitalized medical patients, outpatients with cancer, the chronically immobilized, long-distance travelers, and those with asymptomatic thrombophilia.
Target Patient Population
Hospitalized medical patients, outpatients with cancer, the chronically immobilized, long-distance travelers, and those with asymptomatic thrombophilia
Inclusion Criteria
Male, Female, Adolescent, Adult, Older adult
Health Care Settings
Ambulatory, Emergency care, Hospital, Long term care, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Assessment and screening, Management, Prevention
Diseases/Conditions (MeSH)
D054556 - Venous Thromboembolism, D000925 - Anticoagulants, D011315 - Preventive Medicine, D057236 - Travel Medicine, D056824 - Upper Extremity Deep Vein Thrombosis, D007103 - Immobilization
Keywords
cancer, anticoagulation, immobility, antiplatelet agents, Antithrombotic Agents, Venous Thromboembolism, travel medicine, deep venous thrombosis, thrombophilia, Anticoagulation