CHEST Guidelines-Prevention-of-VTE-in-Nonsurgical-Patients

Prevention-of-VTE-in-Nonsurgical-Patients_chest

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The document summarizes the 9th edition of the American College of Chest Physicians (ACCP) guidelines on antithrombotic therapy and the prevention of thrombosis. It specifically focuses on nonsurgical patients, detailing recommendations for various groups at risk of venous thromboembolism (VTE), including hospitalized patients, cancer outpatients, critically ill patients, and long-distance travelers.<br /><br />For hospitalized patients at increased risk of thrombosis, the guidelines recommend anticoagulant thromboprophylaxis using low-molecular-weight heparin (LMWH), low-dose unfractionated heparin (LDUH), or fondaparinux. There is a suggestion against extending thromboprophylaxis beyond the period of immobilization. For those at low risk, pharmacologic or mechanical prophylaxis is not recommended.<br /><br />Cancer outpatients without additional VTE risk factors are advised against routine prophylaxis with LMWH or LDUH and the use of vitamin K antagonists. However, for those with additional risk factors, prophylactic-dose LMWH or LDUH is suggested.<br /><br />For critically ill patients, LMWH or LDUH thromboprophylaxis is recommended, with a suggestion to use mechanical prophylaxis in those at high bleeding risk. The use of routine ultrasound screening for deep vein thrombosis (DVT) is not recommended in critically ill patients.<br /><br />The guidelines also address thromboprophylaxis for long-distance travelers and individuals with asymptomatic thrombophilia but do not advocate prophylaxis except under certain circumstances, indicating a case-by-case evaluation.<br /><br />Additionally, the guidelines highlight methods for improving adherence to recommended VTE prophylaxis regimens and stress the importance of considering patient preferences, potential side effects, and costs in decision-making. Statin use for VTE prevention is deliberated but not recommended due to limited data.<br /><br />Overall, these guidelines focus on personalized care, balancing benefits and risks while considering patient-specific factors and current evidence.

Keywords

ACCP guidelines

antithrombotic therapy

venous thromboembolism

nonsurgical patients

thromboprophylaxis

low-molecular-weight heparin

cancer outpatients

critically ill patients

long-distance travelers

personalized care