CHEST Guidelines-Prevention-of-VTE-in-Nonorthopedic-Surgical-Patien

Prevention-of-VTE-in-Nonorthopedic-Surgical-Patien

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The American College of Chest Physicians (ACCP) issued guidelines for antithrombotic therapy and thrombosis prevention in its 9th edition. The guidelines focus on preventing venous thromboembolism (VTE), a notable cause of preventable death in surgical patients. It recommends varying strategies based on VTE risks and bleeding potentials in non-orthopedic surgical patients.<br /><br />For patients with very low VTE risk (less than 0.5%), the guidelines suggest no pharmacologic or mechanical prophylaxis besides encouraging early ambulation. Low VTE risk patients (1.5%) are suggested to use mechanical prophylaxis, such as intermittent pneumatic compression (IPC), whereas moderate-risk patients (3%) can use low-molecular-weight heparin (LMWH), low-dose unfractionated heparin (LDUH), or IPC unless bleeding risks are high. High VTE risk patients (6%) should receive pharmacologic prophylaxis with LMWH or LDUH, and adding mechanical prophylaxis is recommended.<br /><br />Particularly, patients with high VTE risk undergoing abdominal or pelvic cancer surgery should extend pharmacologic prophylaxis to four weeks post-operation. For high bleeding risk or severe bleeding consequence patients, mechanical prophylaxis (preferably with IPC) is recommended until bleeding risks diminish enough to consider pharmacologic interventions.<br /><br />The guidelines advise against using inferior vena cava (IVC) filters for primary VTE prevention and discourage venous compression ultrasound (VCU) surveillance. Recommendations for other surgical populations take a similar approach as with general and abdominal-pelvic surgeries.<br /><br />In craniotomy patients, mechanical prophylaxis with IPC is advised, adding pharmacologic measures only when hemostasis is adequate to handle bleeding risks. For spinal surgery patients at high VTE risk, adding pharmacologic prophylaxis is suggested alongside mechanical prophylaxis, after ensuring bleeding conditions are stable.<br /><br />Ultimately, these guidelines underscore optimizing thromboprophylaxis centered on VTE and bleeding risk assessment alongside patients' preferences and values. They highlight an evidence-based approach to maximizing VTE prevention with minimal bleeding risks for individual non-orthopedic surgical patients.

Keywords

American College of Chest Physicians

antithrombotic therapy

thrombosis prevention

venous thromboembolism

surgical patients

pharmacologic prophylaxis

mechanical prophylaxis

bleeding risks

low-molecular-weight heparin

intermittent pneumatic compression