Guidelines for VTE Prophylaxis in Nonsurgical Patients Issued

Guidelines apply to acute and critical patients, outpatients with cancer, long-distance travelers

THURSDAY, Feb. 9 (HealthDay News) -- New evidence-based clinical practice guidelines have been issued for the prophylaxis of venous thromboembolism (VTE) in nonsurgical patients; the guidelines have been published in a supplement to the February issue of CHEST.

Susan R. Kahn, M.D., of McGill University in Montreal, and associates present guidelines for prevention of deep vein thrombosis (DVT) or pulmonary embolism (PE) in nonsurgical populations, including hospitalized medical patients, outpatients with cancer, the chronically immobilized, long-distance travelers, and individuals with asymptomatic thrombophilia.

The authors recommend that, for acutely ill hospitalized patients, treatment should vary according to the risk of thrombosis. For those at increased risk, they recommend anticoagulant thromboprophylaxis with low-molecular-weight heparin (LMWH), low-dose unfractionated heparin (LDUH), or fondaparinux, and suggest against extending the length of thromboprophylaxis beyond the period of acute hospital stay or patient immobilization. For those at low risk of thrombosis, pharmacologic or mechanical prophylaxis is not recommended. For critically ill patients, LMWH or LDUH prophylaxis is recommended. Mechanical prophylaxis is recommended for acute or critical patients who are, or are at risk for, major bleeding. For outpatients with cancer, without additional risk factors for VTE, routine prophylaxis with LMWH or LDUH or vitamin K antagonists is not recommended. For long-distance travelers at increased risk of VTE, frequent ambulation, calf muscle exercise, sitting in an aisle seat, and graduated compression stockings are recommended.

"Decisions regarding prophylaxis in nonsurgical patients should be made after consideration of risk factors for both thrombosis and bleeding, clinical context, and patients' values and preferences," the authors write.

Several of the authors disclosed financial ties to the pharmaceutical industry. The guidelines were partially funded by Bayer Schering Pharma AG, Bristol-Myers Squibb, Pfizer Inc., Canyon Pharmaceuticals, and Sanofi-Aventis US.

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