JC2011-11 Guidelines DVT prophylaxis - Dr. Ha (no narration)

Venous Thromboembolism Prophylaxis in Hospitalized Patients: A Clinical Practice Guideline From the American College of Physicians : 

Venous Thromboembolism Prophylaxis in Hospitalized Patients: A Clinical Practice Guideline From the American College of Physicians Dat Ha, DO

Background : 

Background Venous Thromboembolism (VTE) considered most common preventable cause of hospital-related death VTE prophylaxis has been recommended for nonsurgical patients, but its effectiveness remains uncertain

Purpose: 

Purpose To assess the benefits and harms of prophylaxis in hospitalized adult medical patients & those with acute stroke

Methods : 

Methods Guideline based on literature from MEDLINE and Cochrane Library from 1950 – April 2011, including randomized trials & systematic reviews

Study Selection : 

Study Selection English language randomized trials treatments used to prevent VTE, SC UFH (<20,000 U/d) LMWH mechanical measures graduated compression stockings intermittent pneumatic compression

Exclusions: 

Exclusions not randomized treatment (not prevention) of VTE including warfarin, thrombolytic no non-surgical groups not in English results not from adult groups

PowerPoint Presentation: 

Primary Outcome Total mortality up to 120 days after randomization Secondary Outcomes symptomatic DVT all PE & fatal PE all bleeding events major bleeding event decr Hb >20 g/L transfusion >2u blood life threatening bleeding effects on skin (mechanical)

Key Questions : 

Key Questions What are the benefits and harms of SQ low dose heparin products for VTE prophylaxis? Effectiveness of LMWH vs UFH for VTE prophylaxis? Effectiveness of mechanical devices vs no mechanical devices? Do the results vary between different patient populations: general medical patients vs acute stroke?

Conclusions : 

Conclusions Heparin prophylaxis No significant reduction in mortality may reduce PE increases bleeding UFH vs LMWH prophylaxis No differences in benefits or harm Mechanical prophylaxis No benefits in patients with stroke Increased harm (skin damage)

Questions : 

Questions How will this study change your practice? If you were to follow recommendation 1 in your practice, how would you assess the risks of VTE vs benefits?

Discussion : 

Discussion Assessing risks vs benefits – does everyone need VTE prophylaxis? If so, how long? Risk factors for VTE –Risk assessment tools? Inherited – factor V Leiden, protein S & C def, antithrombin def, prothrombin gene mutation, Acquired – surgery, cancer, immobilization, hx VTE, central lines, pregnancy, older age, etc More study should be conducted to assess benefits of mechanical PPX in patients who have contraindication for heparin products

Special Thanks : 

Special Thanks Dr. Green-Yeh Dr. Nelson