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prophylaxis for venous thromboembolism (VTE)

Indications: 1) surgery a) orthopedic surgery b) surgery for gynecologic cancer [19] c) neurosurgery d) post hospital discharge VTE prophylaxis for - hip fracture repair - hip arthroplasty - knee arthroplasty - major cancer surgery 2) acute spinal cord injury with leg paralysis 3) *multiple trauma 4) hospitalization, immobilization 5) hypercoagulability - hypercoagulabity of malignancy (see Khorana Risk Score) 6) recurrent deep vein thrombosis 7) high-risk patients with lung cancer or gastrointestinal cancer [53] Clinical significance: - reduces incidence of DVT & pulmonary embolism in at risk patients - does not reduce mortality [13,25] - no strong evidence that postoperative anticoagulation lowers incidence of fatal pulmonary embolism [44] Management: 1) general surgery a) low risk:* no prophylaxis - Caprini score = 0 -> early ambulation - Caprini score = 1-2 -> intermittent pneumatic compression - low to moderate risk non-orthopedic surgery patients do not benefit from chemoprophylaxis for venous thromboembolism [50] b) moderate-high risk:* (includes cancer patients) - Caprini score >= 3 - unfractionated heparin vs LMH heparin + intermittent pneumatic compression - unfractionated heparin - 5000 U SC 2 hours preoperatively - 5000 U SC every 8 hours postoperatively - dalteparin - 2500 U SC 2 hours preoperatively - 2500-5000 U SC QD postoperatively - continue for 28 days postoperatively in cancer patients [1] (abdominal cancer surgery especially high risk) - other LMW heparin c) very high risk:* - unfractionated heparin vs dalteparin - intermittent pneumatic compression (intraoperatively) - perioperative warfarin, INR 2.0-3.0 d) do not use pharmacologic prophylaxis if high risk of bleeding - pharmacologic prophylaxis preferable to intermittent compression devices unless risks of bleeding outweigh benefits [12] - pharmacologic prophylaxis in combination with intermittent compression device unless risks of bleeding outweigh benefits [1] e) pneumatic compression devices - not useful when added to pharmacologic prophylaxis in critically ill [39] - useful when pharmacologic prophylaxis is contraindicated - not recommended as only prophylaxis unless increased risk of bleeding [1] - intermittent pneumatic compression# for 10 days after hip or knee surgery (in addition to 35 days of pharmacologic prophylaxis) f) compression stockings - do not use compression stockings for prophylaxis [1,12,35] - skin damgage cited as harm [12] - intermittent compression devices may be considered [35] - graduated compression stockings for post surgical patients - number needed to treat to prevent 1 DVT = 7-9 [28] - unknown number harmed from discomfort [28] - effectiveness of graduated compression stockings for hospitalized medical patients is uncertain [28] g) rates of venous thromboembolism in hospitalized post-op surgical patients correlates directly rather than inversely with rates of prophylaxis, suggesting vigilance for VTE rather than prophylaxis determines rate of VTE [22] 2) major orthopedic surgery (includes osteotomy, arthroplasty) - minimum or 10-14 days after orthopedic surgery [1] - in patients without bleeding risk, up to 35 days preferable [1] - LMW heparin or fondaparinux during hospitalization & for 6 weeks after discharge 3) total hip replacement a) postoperative enoxaparin 30-40 mg SC every 12 hours for 30 days, begun 12-24 hours preoperatively b) fondaparinux (Arixtra) - more effective than LMW heparin following orthopedic surgery [1] - 2.5 mg SC QD c) intermittent pneumatic compression# for 10 days d) warfarin (see direct oral anticoagulant (DOAC) for safety vs warfarin) - begun preoperatively - adjusted to INR 2.0-3.0 postoperatively - continued for 4-5 weeks e) may be safely carried out with INR < 2.0 f) enoxaparin 40 mg SC QD for 1 month [2] g) factor Xa inhibitors more effective than LMW heparin [16,17] h) rivaroxaban 10 mg QD for 14 days [33] i) rivaroxaban 10 mg QD for 5 days followed by aspirin 81 mg QD for 9 days as effective as rivaroxaban for 14 days [33] j) aspirin 162 mg/day? may be option [42] 4) hip fracture surgery a) enoxaparin 30 mg SC every 12 hours begun 12 hours preoperatively for 30 days + pneumatic compression device# for 10 days [5] b) fondaparinux (Arixtra) - more effective than LMW heparin following orthopedic surgery [1] - 2.5 mg SC QD c) warfarin adjusted to INR 2.0-3.0 (see DOAC for safety vs warfarin) d) aspirin 162 mg/day if other options not viable [15] - aspirin associated with similar mortality & pulmonary embolism as enoxaparin; DVT (most distal) more common with aspirin (2.5% vs 1.7%) [51] 5) total knee replacement [5] a) postoperative enoxaparin 30 mg SC every 12 hours for 30 days begun 12-24 hours preoperatively b) fondaparinux (Arixtra) - more effective than LMW heparin following orthopedic surgery [1] - 2.5 mg SC QD c) intermittent pneumatic compression# for 10 days d) may be safely carried out with INR < 2.0 e) warfarin continued for 30 days is alternative (see DOAC for safety vs warfarin) [1] f) factor Xa inhibitors more effective than LMW heparin [16,17] g) aspirin 162 mg/day if other options not viable [15,42] h) rivaroxaban 10 mg QD for 14 days [33] i) rivaroxaban 10 mg QD for 5 days followed by aspirin 81 mg QD for 9 days as effective as rivaroxaban for 14 days [33] i) rivaroxaban monotherapy is the most effective strategy for preventing DVT after elective total knee replacement [41] 6) knee arthroscopy, low risk -> early ambulation 7) lower leg orthopedic surgery a) lower leg, ankle or foot surgery - no VTE prophylaxis - tradeoffs between VTE prevention & bleeding [40] b) isolated lower leg fracture repair - no VTE prophylaxis 8) neurosurgery (1 or 2, or 1 & 2) a) intermittent pneumatic compression immediately following cranial surgery [1] b) LMW heparin or warfarin 9) acute spinal cord injury with leg paralysis (1 or 2 or 3) a) unfractionated heparin SC adjusted to aPTT 1.5 x control 6 hours after dose b) warfarin adjusted to INR of 2.0-3.0 c) intermittent pneumatic compression plus unfractionated heparin 5000 U SC every 12 hours 10) multiple trauma (1, then 2 or 3) a) intermittent pneumatic compression until bleeding is unlikely b) enoxaparin 30 mg SC every 12 hours c) warfarin adjusted to INR of 2.0-3.0 11) myocardial infarction# - unfractionated heparin 5000 U SC every 12 hours 12) stroke# a) heparin, LMW heparin, warfarin contraindicated in patients within 4 days of hemorrhagic stroke - LMW heparin or unfractionated heparin recommended in patients with stable hemorrhagic stroke by hospital day 4 [1] b) ischemic stroke - ischemic stroke with paralysis - unfractionated heparin 5000 U SC every 12 hours - neither unfractionated heparin nor LMW heparin significantly effects mortality [12] c) mechanical prophylaxis (including TED hose) provides no benefit & results in clinically important harm to patients with stroke [29] 13) medical patient# expected to be at best rest for at least 4 days, especially the elderly with chronic disease [6] a) unfractionated heparin 5000 U SC every 12 hours b) low molecular weight heparin (LMW heparin) 40 mg QD or 30 mg BID c) LMW heparin vs unfractionated heparin - no apparent benefit of LMW heparin over unfractionated heparin in ICU patients [11] - LMW heparin may reduce hospital costs due to pulmonary embolism & heparin-induced thrombocytopenia [26] - LMW heparin with better benefit/risk ratio than unfractionated heparin or direct-acting oral anticoagulants in hospitalized patients [48] d) high-risk acutely ill patients may benefit from extended prophylaxis [10] e) neither unfractionated heparin nor LMW heparin significantly effects mortality [12,13] f) uncertain benefit in frail elderly [27] g) extended anticoagulation with factor Xa inhibitor for additional 35-42 days may diminish incidence of VTE at the cost of higher risk of bleeding [31] h) extended VTE prophylaxis with rivaroxaban after nonsurgical hospitalization of no benefit [37] 14) cataracts or lens implantation - excessive bleeding does not occur when INR < 2.5 15) arthroplasty, gastrectomy, cholecystectomy, major gynecologic surgery may be safely carried out with INR < 2.0 16) hypercoagulability of malignancy a) routine prophylaxis for venous thromboembolism not indicated for all outpatients with cancer [1] b) Khorana Risk score estimates risk of thrombosis in cancer patients [1] c) inpatient & high risk patients - compared with LMW heparin & warfarin, direct oral anticoagulants are associated with better medication compliance, lower incidence of venous thromboembolism, lower risk of bleeding & lower mortality [52] - apixaban beneficial for prevention of venous thromboembolism in patients with cancer [38], including Asians [43] - long-term LMW heparin - subsequent transition to warfarin or apixaban after 3-6 months if malignancy is no longer active [1,8] - for recurrent venous thromboembolism switch to full dose LMW heparin if on warfarin [24] - if thrombosis recurs despite full dose LMW heparin, increase dose by 25% & reassess in 5-7 days [24] - for thrombocytopenia & acute venous thromboembolism - give platelets as needed to maintain platelet count > 50,000/uL - full dose LMW heparin for platelet count > 50,000/uL - 50% dose LMW heparin for platelet count > 25,000/uL - discontinue LMW heparin for platelet count < 25,000/uL [24] - for major or life-threatening bleeding, withhold anticoagulation & insert a retrievable vena cava umbrella - when bleeding has resolved, resume anticoagulation & remove the filter [24 - cancer surgery: enoxaparin 40 mg SC QD for 1 month [1,3]; >= 7-10 days [46] 17) coagulation factor deficiency - LMW heparin 18) recurrent deep vein thrombosis a) anticoagulation with warfarin, INR = 2.0-3.0 (90% effective) b) low-intensity anticoagulation, INR = 1.5-2.0 (75% effective) c) risk of bleeding no different [4] d) low-dose aspirin is safer, but less effective [18] 19) bed-bound patients in nursing home or at home a) risk of DVT is high b) absence of evidence for benefit of prophylaxis [9] 20) pregnant women with prior venous thromboembolism - weight-based low dose low molecular weight heparin 40-60 mg once daily held at the time of deliver & continued 6 weeks postpartum [49] - intermediate dose low molecular weight heparin 60-120 mg once daily with similar outcomes [49] 21) low-risk patients - rosuvastatin & other statins may further reduce risk [7] 22) life-long anticoagulation for: a) 2 or more spontaneous episodes of DVT b) 1 spontaneous, life-threatening venous thromoembolism c) 1 spontaneous venous thromboembolism in a patient with hypercoagulability * see perioperative risk stratification # TED hose not effective [5]; data supporting efficacy of pneumatic compression devices are almost exclusively limited to surgical patients [1,20] Notes: - warfarin more effective for secondary prevention of VTE than dabigatran, rivaroxaban & apixaban, but associated with greater risk of major hemorrhage [23] - IMPROVE BRS & IMPROVE VTE risk scores, calculated at hospital admission, may be helpful in decisions regarding pharmacologic prophylaxis for VTE [30] - excessive venous thromboembolism prophylaxis in hospitalized patients, particularly in low-risk patients [36] - high-intensity statin in combination with PCSK9 inhibitor may reduce risk of venous thromboembolism [54]* * unlikely to become a standard of care

Related

deep vein thrombosis (DVT)

General

prophylaxis for thromboembolism

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2006, 2009, 2012, 2015, 2018, 2021. - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  2. Journal Watch 22(9):69, 2002 Journal Watch 16(20):158, 1996 N Engl J Med 335:696, 1996
  3. Journal Watch 22(9):69, 2002 Bergqvist D et al Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer. N Engl J Med 346:975, 2002 PMID: 11919306
  4. Prescriber's Letter 10(9):49 2003
  5. Journal Watch 24(19):151, 2004 Silbersack Y, Taute BM, Hein W, Podhaisky H. Prevention of deep-vein thrombosis after total hip and knee replacement. Low-molecular-weight heparin in combination with intermittent pneumatic compression. J Bone Joint Surg Br. 2004 Aug;86(6):809-12. PMID: 15330019
  6. Cohen AT, Davidson BL, Gallus AS, Lassen MR, Prins MH, Tomkowski W, Turpie AG, Egberts JF, Lensing AW; ARTEMIS Investigators. Efficacy and safety of fondaparinux for the prevention of venous thromboembolism in older acute medical patients: randomised placebo controlled trial. BMJ. 2006 Feb 11;332(7537):325-9. Epub 2006 Jan 26. PMID: 16439370
  7. Glynn RJ et al A randomized trial of rosuvastatin in the prevention of venous thromboembolism. N Engl J Med 2009 Mar 29 PMID: 19329822 - Prescriber's Letter 16(5) 2000 Statins for Venous Thromboembolism Prevention Detail-Document#: 250503 (subscription needed) http://www.prescribersletter.com
  8. Lee AY et al Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med. 2003 Jul 10;349(2):146-53 PMID: 12853587
  9. Gatt ME et al Is prolonged immobilization a risk factor for symptomatic venous thromboembolism in elderly bedridden patients? Results of a historical cohort study. Thromb Haemost 2005 91(3):538 PMID: 14983230 - Bosson JL et al Deep vein thrombosis in elderly patients hospitalized in subacute care facilities: a multicenter cross-sectional study of risk factors, prophylaxis, and prevalence. Arch Intern Med 2003, 163(21):2613 PMID: 14638561
  10. Hull RD et al. Extended-duration venous thromboembolism prophylaxis in acutely ill medical patients with recently reduced mobility: A randomized trial. Ann Intern Med 2010 Jul 6; 153:8. PMID: 20621900
  11. Cook D et al for The PROTECT Investigators for the Canadian Critical Care Trials Group and the Australian and New Zealand Intensive Care Society Clinical Trials Group Dalteparin versus Unfractionated Heparin in Critically Ill Patients New Engl J Med March 22, 2011 PMID: 21417952 http://www.nejm.org/doi/pdf/10.1056/NEJMoa1014475
  12. Lederle FA et al Venous Thromboembolism Prophylaxis in Hospitalized Medical Patients and Those With Stroke: A Background Review for an American College of Physicians Clinical Practice Guideline Annals of Internal Medicine November 1, 2011 155(9):602-615 PMID: 22041949 http://www.annals.org/content/155/9/602.abstract corresponding NGC guideline withdrawn Nov 2016 - Qaseem A et al Venous Thromboembolism Prophylaxis in Hospitalized Patients: A Clinical Practice Guideline From the American College of Physicians Annals of Internal Medicine November 1, 2011 155(9):625-682 http://www.annals.org/content/155/9/625.full.pdf+html corresponding NGC guideline withdrawn Nov 2016
  13. Kakkar AK et al. Low-molecular-weight heparin and mortality in acutely ill medical patients. N Engl J Med 2011 Dec 29; 365:2463 PMID: 22204723
  14. Guyatt GH et al Executive Summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines CHEST February 2012 vol. 141 no. 2 suppl 7S-47S PMID: 22315257 http://chestjournal.chestpubs.org/content/141/2_suppl/7S.full - Alonso-Coello P et al Antithrombotic Therapy in Peripheral Artery Disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines Chest. 2012 Feb;141(2 Suppl):e669S-90S. PMID: 22315275 (corresponding NGC guideline withdrawn Dec 2017)
  15. Prescriber's Letter 19(3): 2012 COMMENTARY: Aspirin for VTE Prophylaxis After Hip or Knee Replacement CHART: Drug Options for VTE Prophylaxis After Hip or Knee Replacement Detail-Document#: 280325 (subscription needed) http://www.prescribersletter.com
  16. Neumann I et al. Oral direct factor Xa inhibitors versus low-molecular-weight heparin to prevent venous thromboembolism in patients undergoing total hip or knee replacement: A systematic review and meta-analysis. Ann Intern Med 2012 May 15; 156:710. PMID: 22412038 - Sobieraj DM et al. Prolonged versus standard-duration venous thromboprophylaxis in major orthopedic surgery: A systematic review. Ann Intern Med 2012 May 15; 156:720. PMID: 22412039
  17. Gomez-Outes A et al. Dabigatran, rivaroxaban, or apixaban versus enoxaparin for thromboprophylaxis after total hip or knee replacement: Systematic review, meta-analysis, and indirect treatment comparisons. BMJ 2012 Jun 14; 344:e3675 PMID: 22700784
  18. Becattini C et al. Aspirin for preventing the recurrence of venous thromboembolism. N Engl J Med 2012 May 24; 366:1959 PMID: 22621626 - Brighton TA et al. Low-dose aspirin for preventing recurrent venous thromboembolism. N Engl J Med 2012 Nov 4; PMID: 23121403 http://www.nejm.org/doi/full/10.1056/NEJMoa1210384
  19. Guyatt GH, Akl EA, Crowther M et al Introduction to the ninth edition: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141(2 Suppl):48S-52S PMID: 22315255 - Holbrook A, Schulman S, Witt DM et al Evidence-based management of anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141(2 Suppl):e152S-84S PMID: 22315259 (corresponding NGC guideline withdrawn Dec 2017) - Kahn SR, Lim W, Dunn AS, Cushman M et al Prevention of VTE in nonsurgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141(2 Suppl):e195S-226S PMID: 22315261 (corresponding NGC guideline withdrawn Dec 2017) - Gould MK, Garcia DA, Wren SM et al Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141(2 Suppl):e227S-77S PMID: 22315263 (corresponding NGC guideline withdrawn Dec 2017) - Falck-Ytter Y, Francis CW, Johanson NA et al Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141(2 Suppl):e278S-325S. PMID: 22315265 (corresponding NGC guideline withdrawn Dec 2017) - Kearon C, Akl EA, Comerota AJ, Prandoni P et al Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141(2 Suppl):e419S-94S. PMID: 22315268
  20. Mismetti P, Laporte-Simitsidis S, Tardy B et al Prevention of venous thromboembolism in internal medicine with unfractionated or low-molecular-weight heparins: a meta-analysis of randomised clinical trials. Thromb Haemost. 2000 Jan;83(1):14-9. PMID: 10669147 - Mismetti P, Laporte S, Darmon JY et al Meta-analysis of low molecular weight heparin in the prevention of venous thromboembolism in general surgery. Br J Surg. 2001 Jul;88(7):913-30. PMID: 11442521
  21. Qaseem A, Chou R, Humphrey LL et al Venous thromboembolism prophylaxis in hospitalized patients: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2011 Nov 1;155(9):625-32 PMID: 22041951 (corresponding NGC guideline withdrawn Nov 2016)
  22. Bilimoria KY et al Evaluation of Surveillance Bias and the Validity of the Venous Thromboembolism Quality Measure. JAMA. 2013;310(14):1482-1489 PMID: 24100354 http://jama.jamanetwork.com/article.aspx?articleid=1748150 - Livingston EH Postoperative Venous Thromboembolic Disease Prevention, Public Reporting, and Patient Protection. JAMA. 2013;310(14):1453-1454. PMID: 24101098 http://jama.jamanetwork.com/article.aspx?articleid=1748147
  23. Castellucci LA et al. Efficacy and safety outcomes of oral anticoagulants and antiplatelet drugs in the secondary prevention of venous thromboembolism: Systematic review and network meta-analysis. BMJ 2013 Aug 30; 347:f5133 PMID: 23996149 http://www.bmj.com/content/347/bmj.f5133
  24. Carrier M et al. Management of challenging cases of patients with cancer- associated thrombosis including recurrent thrombosis and bleeding: Guidance from the SSC of the ISTH. J Thromb Haemost 2013 Sep; 11:1760 PMID: 23809334 http://onlinelibrary.wiley.com/doi/10.1111/jth.12338/abstract - Oo TH Management of challenging cases of patients with cancer- associated thrombosis including recurrent thrombosis and bleeding: guidance from the SSC of the ISTH: a rebuttal. J Thromb Haemost. 2013 Oct 24 PMID: 24152379
  25. Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013 - Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022 - Sugiyama T An update on hip fracture risk associated with anticoagulant therapy: warfarin versus direct oral anticoagulants. Expert Opinion on Drug Safety. 2020 19(10):1219-1220 PMID: 32795203
  26. Fowler RA et al Cost-effectiveness of Dalteparin vs Unfractionated Heparin for the Prevention of Venous Thromboembolism in Critically Ill Patients. JAMA. Published online November 01, 2014 PMID: 25362228 http://jama.jamanetwork.com/article.aspx?articleID=1921813
  27. Greig MF, Rochow SB, Crilly MA, Mangoni AA. Routine pharmacological venous thromboembolism prophylaxis in frail older hospitalised patients: where is the evidence? Age Ageing. 2013;42:428-434 PMID: 23557678 - Akl EA, Guyatt G. ACP Journal Club. Review: Routine venous thromboembolism prophylaxis in hospitalized frail older patients has uncertain benefit. Ann Intern Med. 2013 Jul 16;159(2):JC9. PMID: 23856707
  28. The NNT: Elastic Stockings for Deep Vein Thrombosis Prevention After Surgery. http://www.thennt.com/nnt/elastic-stockings-for-deep-vein-thrombosis-prevention-after-surgery/ - The NNT: Elastic Stockings Plus Medical Therapy for Deep Vein Thrombosis Prevention After Surgery. http://www.thennt.com/nnt/elastic-stockings-plus-medical-therapy-for-deep-vein-thrombosis-prevention-after-surgery/ - Sachdeva A, Dalton M, Amaragiri SV, Lees T. Graduated compression stockings for prevention of deep vein thrombosis. Cochrane Database Syst Rev. 2014 Dec 17;12:CD001484. Review. PMID: 25517473
  29. The NNT: Graduated Compression Stockings for Prevention of Deep Vein Thrombosis in Stroke Patients - Naccarato M, Chiodo Grandi F, Dennis M, Sandercock PA. Physical methods for preventing deep vein thrombosis in stroke. Cochrane Database Syst Rev. 2010 Aug 4;(8):CD001922 PMID: 20687069
  30. Hostler DC et al. Validation of the International Medical Prevention Registry on Venous Thromboembolism bleeding risk score. Chest 2016 Feb; 149:372 PMID: 26867833
  31. Cohen AT, Harrington RA, Goldhaber SZ et al. Extended thromboprophylaxis with betrixaban in acutely ill medical patients. N Engl J Med 2016 May 27 PMID: 27232649
  32. Balk EM, Ellis AG, Di M, Adam GP, Trikalinos TA. Venous Thromboembolism Prophylaxis in Major Orthopedic Surgery: Systematic Review Update. Systematic Review Update. Comparative Effectiveness Review No. 191. (Prepared by the Brown Evidence-based Practice Center under Contract No. 290-2015-00002-I.) AHRQ Publication No. 17-EHC021-EF. Rockville, MD: Agency for Healthcare Research and Quality; June 2017. http://www.effectivehealthcare.ahrq.gov/reports/final.cfm
  33. Anderson DR, Dunbar M, Murnaghan J Aspirin or Rivaroxaban for VTE Prophylaxis after Hip or Knee Arthroplasty. N Engl J Med 2018; 378:699-707. Feb 22, 2018 PMID: 29466159 http://www.nejm.org/doi/full/10.1056/NEJMoa1712746
  34. NEJM Knowledge+ Question of the Week. Feb 6, 2018 https://knowledgeplus.nejm.org/question-of-week/1594/
  35. American Academy of Nursing Twenty-Five Things Nurses and Patients Should Question Choosing Wisely. An initiative of the ABIM Foundation Released April 19, 2018 (21-25) http://www.choosingwisely.org/societies/american-academy-of-nursing/
  36. Grant PJ, Conlon A, Chopra V, Flanders SA. Use of venous thromboembolism prophylaxis in hospitalized patients. JAMA Intern Med 2018 May 21 PMID: 29800008
  37. Spyropoulos AC, Ageno W, Albers GW et al. Rivaroxaban for thromboprophylaxis after hospitalization for medical illness. N Engl J Med 2018 Aug 26; PMID: 30145946 Free full text https://www.nejm.org/doi/10.1056/NEJMoa1805090
  38. Carrier M, Abou-Nassar K, Mallick R et al Apixaban to Prevent Venous Thromboembolism in Patients with Cancer. N Engl J Med. Dec 3, 2018 PMID: 30511879 https://www.nejm.org/doi/full/10.1056/NEJMoa1814468
  39. Arabi YM, Al-Hameed F, Burns KEA et al. Adjunctive intermittent pneumatic compression for venous thromboprophylaxis. N Engl J Med 2019 Feb 18; PMID: 30779530 https://www.nejm.org/doi/10.1056/NEJMoa1816150
  40. Heijboer RRO, Lubberts B, Guss D, Johnson AH, Moon DK, DiGiovanni CW. Venous thromboembolism and bleeding adverse events in lower leg, ankle, and foot orthopaedic surgery with and without anticoagulants. J Bone Joint Surg Am 2019 Mar 20; 101:539 PMID: 30893235
  41. Lewis S, Glen J, Dawoud D et al Venous thromboembolism prophylaxis strategies for people undergoing elective total knee replacement: a systematic review and network meta-analysis. Lancet Haematology. Published:August 20, 2019 PMID: 31426937 https://www.thelancet.com/journals/lanhae/article/PIIS2352-3026(19)30155-3/fulltext - Koziel M, Lip GYH Venous thromboembolism prophylaxis strategies for patients undergoing elective total knee replacement. Lancet Haematology. Published:August 20, 2019 PMID: 31444125 https://www.thelancet.com/journals/lanhae/article/PIIS2352-3026(19)30164-4/fulltext
  42. Matharu GS, Kunutsor SK, Judge A et al Clinical Effectiveness and Safety of Aspirin for Venous Thromboembolism Prophylaxis After Total Hip and Knee Replacement. A Systematic Review and Meta-analysis of Randomized Clinical Trials. JAMA Intern Med. Published online February 3, 2020. PMID: 32011647 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2759736
  43. Chen CY, Tseng CN, Hsieh MJ et al Comparison Between Non-vitamin K Antagonist Oral Anticoagulants and Low-Molecular-Weight Heparin in Asian Individuals With Cancer-Associated Venous Thromboembolism. JAMA Netw Open. 2021;4(2):e2036304 PMID: 33533929 Free article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2775823
  44. ICM-VTE General Delegates. Recommendations from the ICM-VTE: General. J Bone Joint Surg Am 2022 Mar 16; 104:Suppl 1:4. PMID: 35315607 https://journals.lww.com/jbjsjournal/Fulltext/2022/03161/Recommendations_from_the_ICM_VTE__General.2.aspx - ICM-VTE Hip & Knee Delegates. Recommendations from the ICM-VTE: Hip & Knee. J Bone Joint Surg Am 2022 Mar 16; 104:Suppl 1:180 PMID: 35315610 https://journals.lww.com/jbjsjournal/Fulltext/2022/03161/Recommendations_from_the_ICM_VTE__Hip___Knee.5.aspx
  45. Schunemann HJ, Cushman M, Burnett AE et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: prophylaxis for hospitalized and non-hospitalized medical patients. PMID: 30482763 PMCID: PMC6258910 Free PMC article
  46. Key NS, Khorana AA, Kuderer NM Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Clinical Practice Guideline Update. J Clin Oncol. 2020 Feb 10;38(5):496-520 PMID: 31381464
  47. Sugiyama T An update on hip fracture risk associated with anticoagulant therapy: warfarin versus direct oral anticoagulants. Expert Opinion on Durg Safety. 2020 19(10):1219-1220 PMID: 32795203
  48. Eck RJ et al. Anticoagulants for thrombosis prophylaxis in acutely ill patients admitted to hospital: Systematic review and network meta-analysis. BMJ 2022 Jul 4; 378:e070022. PMID: 35788047 PMCID: PMC9251634 Free PMC article https://www.bmj.com/content/378/bmj-2022-070022
  49. Bistervels IM et al. Intermediate-dose versus low-dose low-molecular-weight heparin in pregnant and post-partum women with a history of venous thromboembolism (Highlow study): An open-label, multicentre, randomised, controlled trial. Lancet 2022 Oct 28; [e-pub]. PMID: 36354038 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)02128-6/fulltext
  50. Sutzko DC et al. Low to moderate risk non-orthopedic surgical patients do not benefit from VTE chemoprophylaxis. Ann Surg 2022 Dec; 276:e691. PMID: 33214487 https://journals.lww.com/annalsofsurgery/Abstract/2022/12000/Low_to_Moderate_Risk_Non_orthopedic_Surgical.27.aspx
  51. Major Extremity Trauma Research Consortium (METRC). Aspirin or low-molecular-weight heparin for thromboprophylaxis after a fracture. N Engl J Med 2023 Jan 19; 388:203. PMID: 36652352 https://www.nejm.org/doi/10.1056/NEJMoa2205973
  52. Riaz IB et al. Comparative effectiveness of anticoagulants in patients with cancer-associated thrombosis. JAMA Netw Open 2023 Jul 3; 6:e2325283. PMID: 37486628 PMCID: PMC10366701 Free PMC article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2807546
  53. Alexander M et al. Risk-directed ambulatory thromboprophylaxis in lung and gastrointestinal cancers: The TARGET-TP randomized clinical trial. JAMA Oncol 2023 Nov; 9:1536. PMID: 37733336 PMCID: PMC10514890 (available on 2024-09-21) https://jamanetwork.com/journals/jamaoncology/fullarticle/2809873 - Khorana AA. Primary thromboprophylaxis in people with cancer - Where next? JAMA Oncol 2023 Nov; 9:1545. PMID: 37733351 https://jamanetwork.com/journals/jamaoncology/fullarticle/2809877
  54. Farmakis IT, Christodoulou KC, Hobohm L, et al. Lipid lowering for prevention of venous thromboembolism: a network meta-analysis. Eur Heart J. 2024 Jun 14:ehae361 PMID: 38874212