Template:ACCP VTE prophylaxis/9th edition

ACCP VTE Prevention Guidelines (9th edition, 2012; adapted):

• For acutely ill hospitalized medical patients at increased risk of thrombosis, recommend anticoagulant thromboprophylaxis with low-molecular-weight heparin [LMWH], low-dose unfractionated heparin (LDUH) bid, LDUH tid, or fondaparinux (Grade 1B).
• For acutely ill hospitalized medical patients at low risk of thrombosis, recommend against the use of pharmacologic prophylaxis or mechanical prophylaxis (Grade 1B).
• For acutely ill hospitalized medical patients who are bleeding or at high risk for bleeding, recommend against anticoagulant thromboprophylaxis (Grade 1B).
• For acutely ill hospitalized medical patients at increased risk of thrombosis who are bleeding or at high risk for major bleeding, suggest the optimal use of mechanical thromboprophylaxis with graduated compression stockings (GCS) (Grade 2C) or intermittent pneumatic compression (IPC) (Grade 2C), rather than no mechanical thromboprophylaxis. When bleeding risk decreases, and if VTE risk persists, we suggest that pharmacologic thromboprophylaxis be substituted for mechanical thromboprophylaxis (Grade 2B).
• In acutely ill hospitalized medical patients who receive an initial course of thromboprophylaxis, suggest against extending the duration of thromboprophylaxis beyond the period of patient immobilization or acute hospital stay (Grade 2B).
• In critically ill patients, suggest against routine ultrasound screening for DVT (Grade 2C).
• For critically ill patients, suggest using LMWH or LDUH thromboprophylaxis over no prophylaxis (Grade 2C).
• For critically ill patients who are bleeding, or are at high risk for major bleeding, we suggest mechanical thromboprophylaxis with GCS (Grade 2C) or IPC (Grade 2C) until the bleeding risk decreases, rather than no mechanical thromboprophylaxis. When bleeding risk decreases, suggest that pharmacologic thromboprophylaxis be substituted for mechanical thromboprophylaxis (Grade 2C).
• In outpatients with cancer who have no additional risk factors for VTE, suggest against routine prophylaxis with LMWH or LDUH (Grade 2B) and recommend against the prophylactic use of VKAs (Grade 1B).
• In outpatients with solid tumors who have additional risk factors for VTE and who are at low risk of bleeding, suggest prophylactic-dose LMWH or LDUH over no prophylaxis (Grade 2B).
• In outpatients with cancer and indwelling central venous catheters, suggest against routine prophylaxis with LMWH or LDUH (Grade 2B) and suggest against the prophylactic use of VKAs (Grade 2C).
• In chronically immobilized persons residing at home or at a nursing home, suggest against the routine use of thromboprophylaxis (Grade 2C).
• 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), suggest frequent ambulation, calf muscle exercise, or sitting in an aisle seat if feasible (Grade 2C).
• 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), suggest use of properly fitted, below-knee GCS providing 15 to 30 mm Hg of pressure at the ankle during travel (Grade 2C). For all other long-distance travelers, suggest against the use of GCS (Grade 2C).
• For long-distance travelers, suggest against the use of aspirin or anticoagulants to prevent VTE (Grade 2C).
• In persons with asymptomatic thrombophilia (ie, without a previous history of VTE), recommend against the long-term daily use of mechanical or pharmacologic thromboprophylaxis to prevent VTE (Grade 1C).