David R Anderson1, Gian Paolo Morgano2, Carole Bennett3, Francesco Dentali4, Charles W Francis5, David A Garcia6, Susan R Kahn7, Maryam Rahman8, Anita Rajasekhar9, Frederick B Rogers10, Maureen A Smythe11,12, Kari A O Tikkinen13,14, Adolph J Yates15, Tejan Baldeh2, Sara Balduzzi16, Jan L Brożek2,17, Itziar Etxeandia- Ikobaltzeta2, Herman Johal18, Ignacio Neumann19, Wojtek Wiercioch2, Juan José Yepes-Nuñez20, Holger J Schünemann2,17, Philipp Dahm21,22. 1. Department of Medicine, Dalhousie University, Halifax, NS, Canada. 2. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada. 3. Shreveport, LA. 4. Department of Medicine and Surgery, Insubria University, Varese, Italy. 5. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY. 6. Division of Hematology, Department of Medicine, University of Washington Medical Center, University of Washington School of Medicine, Seattle, WA. 7. Department of Medicine, McGill University and Lady Davis Institute, Montreal, QC, Canada. 8. Lillian S. Wells Department of Neurosurgery and. 9. Division of Hematology and Oncology, Department of Medicine, University of Florida, Gainesville, FL. 10. Trauma and Acute Care Surgery, Penn Medicine Lancaster General Health, Lancaster, PA. 11. Department of Pharmaceutical Services, Beaumont Hospital, Royal Oak, MI. 12. Department of Pharmacy Practice, Wayne State University, Detroit, MI. 13. Department of Urology and. 14. Department of Public Health, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. 15. Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA. 16. Department of Diagnostic, Clinical, and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy. 17. Department of Medicine and. 18. Center for Evidence-Based Orthopaedics, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada. 19. Department of Internal Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile. 20. School of Medicine, Universidad de los Andes, Bogotá, Colombia. 21. Urology Section, Minneapolis VA Health Care System, Minneapolis, MN; and. 22. Department of Urology, University of Minnesota, Minneapolis, MN.
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.
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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