This article discusses the prevention of venous thromboembolism (VTE) and is part of the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Grade 1 recommendations are strong and indicate that the benefits do or do not outweigh risks, burden, and costs. Grade 2 suggestions imply that individual patient values may lead to different choices. Among the key recommendations: every hospital should develop a formal strategy addressing VTE prevention (Grade 1A); aspirin alone is not recommended as thromboprophylaxis for any patient group (Grade 1A); mechanical methods should be used primarily for patients at high bleeding risk (Grade 1A). For elective hip or knee arthroplasty, one of LMWH, fondaparinux, or a VKA (INR target 2.5, range 2.0-3.0) is recommended (each Grade 1A). For hip fracture surgery, fondaparinux (Grade 1A), LMWH (Grade 1B), VKA (Grade 1B), or LDUH (Grade 1B) is recommended. Patients undergoing hip/knee arthroplasty or HFS should receive thromboprophylaxis for a minimum of 10 days (Grade 1A); for hip arthroplasty and HFS, continuing beyond 10 days up to 35 days is recommended (Grade 1A).
Copyright remains with the authors and publisher.
This article discusses the prevention of venous thromboembolism (VTE) and is part of the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Grade 1 recommendations are strong and indicate that the benefits do or do not outweigh risks, burden, and costs. Grade 2 suggestions imply that individual patient values may lead to different choices. Among the key recommendations: every hospital should develop a formal strategy addressing VTE prevention (Grade 1A); aspirin alone is not recommended as thromboprophylaxis for any patient group (Grade 1A); mechanical methods should be used primarily for patients at high bleeding risk (Grade 1A). For elective hip or knee arthroplasty, one of LMWH, fondaparinux, or a VKA (INR target 2.5, range 2.0-3.0) is recommended (each Grade 1A). For hip fracture surgery, fondaparinux (Grade 1A), LMWH (Grade 1B), VKA (Grade 1B), or LDUH (Grade 1B) is recommended. Patients undergoing hip/knee arthroplasty or HFS should receive thromboprophylaxis for a minimum of 10 days (Grade 1A); for hip arthroplasty and HFS, continuing beyond 10 days up to 35 days is recommended (Grade 1A).
Copyright remains with the authors and publisher.