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Blood advances
12 10, 2019;3 (23): 3898-3944.

American Society of Hematology 2019 guidelines for management of venous thromboembolism: prevention of venous thromboembolism in surgical hospitalized patients.

David R Anderson, Gian Paolo Morgano, Carole Bennett, Francesco Dentali, Charles W Francis, David A Garcia, Susan R Kahn, Maryam Rahman, Anita Rajasekhar, Frederick B Rogers, Maureen A Smythe, Kari A O Tikkinen, Adolph J Yates, Tejan Baldeh, Sara Balduzzi, Jan L Brożek, Itziar Etxeandia- Ikobaltzeta, Herman Johal, Ignacio Neumann, Wojtek Wiercioch, Juan José Yepes-Nuñez, Holger J Schünemann, Philipp Dahm
Author Information
  1. David R Anderson: Department of Medicine, Dalhousie University, Halifax, NS, Canada.
  2. Gian Paolo Morgano: Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
  3. Carole Bennett: Shreveport, LA.
  4. Francesco Dentali: Department of Medicine and Surgery, Insubria University, Varese, Italy.
  5. Charles W Francis: Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY.
  6. David A Garcia: Division of Hematology, Department of Medicine, University of Washington Medical Center, University of Washington School of Medicine, Seattle, WA.
  7. Susan R Kahn: Department of Medicine, McGill University and Lady Davis Institute, Montreal, QC, Canada.
  8. Maryam Rahman: Lillian S. Wells Department of Neurosurgery and.
  9. Anita Rajasekhar: Division of Hematology and Oncology, Department of Medicine, University of Florida, Gainesville, FL.
  10. Frederick B Rogers: Trauma and Acute Care Surgery, Penn Medicine Lancaster General Health, Lancaster, PA.
  11. Maureen A Smythe: Department of Pharmaceutical Services, Beaumont Hospital, Royal Oak, MI.
  12. Kari A O Tikkinen: Department of Urology and.
  13. Adolph J Yates: Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
  14. Tejan Baldeh: Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
  15. Sara Balduzzi: Department of Diagnostic, Clinical, and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy.
  16. Jan L Brożek: Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
  17. Itziar Etxeandia- Ikobaltzeta: Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
  18. Herman Johal: Center for Evidence-Based Orthopaedics, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada.
  19. Ignacio Neumann: Department of Internal Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
  20. Wojtek Wiercioch: Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
  21. Juan José Yepes-Nuñez: School of Medicine, Universidad de los Andes, Bogotá, Colombia.
  22. Holger J Schünemann: Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
  23. Philipp Dahm: Urology Section, Minneapolis VA Health Care System, Minneapolis, MN; and.
PMID: 31794602 DOI: 10.1182/bloodadvances.2019000975

Abstract

BACKGROUND: Venous thromboembolism (VTE) is a common source of perioperative morbidity and mortality.
OBJECTIVE: These evidence-based guidelines from the American Society of Hematology (ASH) intend to support decision making about preventing VTE in patients undergoing surgery.
METHODS: ASH formed a multidisciplinary guideline panel balanced to minimize bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline-development process, including performing systematic reviews. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence and make recommendations, which were subject to public comment.
RESULTS: The panel agreed on 30 recommendations, including for major surgery in general (n = 8), orthopedic surgery (n = 7), major general surgery (n = 3), major neurosurgical procedures (n = 2), urological surgery (n = 4), cardiac surgery and major vascular surgery (n = 2), major trauma (n = 2), and major gynecological surgery (n = 2).
CONCLUSIONS: For patients undergoing major surgery in general, the panel made conditional recommendations for mechanical prophylaxis over no prophylaxis, for pneumatic compression prophylaxis over graduated compression stockings, and against inferior vena cava filters. In patients undergoing total hip or total knee arthroplasty, conditional recommendations included using either aspirin or anticoagulants, as well as for a direct oral anticoagulant over low-molecular-weight heparin (LMWH). For major general surgery, the panel suggested pharmacological prophylaxis over no prophylaxis, using LMWH or unfractionated heparin. For major neurosurgery, transurethral resection of the prostate, or radical prostatectomy, the panel suggested against pharmacological prophylaxis. For major trauma surgery or major gynecological surgery, the panel suggested pharmacological prophylaxis over no prophylaxis.

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MeSH Term

Hematology
History, 21st Century
Hospitalization
Humans
Surgical Procedures, Operative
United States
Venous Thromboembolism
Historical Article Journal Article
Article has an altmetric score of 42

Word Cloud

Created with Highcharts 10.0.0surgerymajorn=prophylaxispanelpatientsrecommendationsgeneral2undergoingsuggestedpharmacologicalthromboembolismVTEguidelinesAmericanSocietyHematologyASHGRADEincludingtraumagynecologicalconditionalcompressiontotalusingheparinLMWHvenousBACKGROUND:VenouscommonsourceperioperativemorbiditymortalityOBJECTIVE:evidence-basedintendsupportdecisionmakingpreventingMETHODS:formedmultidisciplinaryguidelinebalancedminimizebiasconflictsinterestMcMasterUniversityCentresupportedguideline-developmentprocessperformingsystematicreviewsGradingRecommendationsAssessmentDevelopmentEvaluationapproachusedassessevidencemakesubjectpubliccommentRESULTS:agreed308orthopedic73neurosurgicalproceduresurological4cardiacvascularCONCLUSIONS:mademechanicalpneumaticgraduatedstockingsinferiorvenacavafiltershipkneearthroplastyincludedeitheraspirinanticoagulantswelldirectoralanticoagulantlow-molecular-weightunfractionatedneurosurgerytransurethralresectionprostateradicalprostatectomy2019managementthromboembolism:preventionsurgicalhospitalized

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