Prevention and treatment of surgical thrombosis and thromboembolism.
Reddy Shirisha,Shen Yu-Min, ,
Surgical technology international
Surgical, post-surgical deep vein thrombosis (DVT), or thromboembolism is common and potentially catastrophic. Surgical DVT may lead to either immediate post-surgical morbidity or long-term morbidity by way of post-phlebitic syndrome and chronic venous insufficiency. In addition, surgery-associated pulmonary embolism (PE) may lead to significant morbidity or post-surgical mortality. As this surgical complication is so common, both the North American Consensus Conference Committee, sponsored by the American College of Chest Physicians, and the International Consensus Conference Committee, sponsored by the International Society of Angiology, have convened periodically during the past two decades to analyze the highest-quality published studies and publish clear standards and guidelines for prevention and treatment of surgical DVT and thromboembolism. The latest North American Recommendations were published in 2004 and the latest International Committee recommendations were released in 2006. These recommendations are summarized in this chapter, which offers the clinician the latest guidelines for prevention and treatment of surgery-associated DVT and thromboembolism.
Preoperative management of anticoagulation in the surgical patient: Highlights of the latest guidelines.
Elgamal Hany,Luedi Markus M,Ender Joerg Karl,Meineri Massimiliano
Best practice & research. Clinical anaesthesiology
Oral anticoagulants (OACs) are a class of medications commonly used in the long-term management of patients at risk of thrombosis. They include warfarin and direct oral anticoagulants (DOACs). The aging of the population and improvements in perioperative care have led to an increase in the number of patients on OACs and presenting for different types of elective and emergency surgery. Perioperative management of OACs constitutes a unique challenge. It is based on the quantification of a patient's individual hemorrhagic and thrombotic risk together with the intrinsic surgical bleeding risk. We reviewed current guidelines to define effective discontinuation of OACs, the need for bridging with different anticoagulants, and post-surgery OACs re-initiation. We also discussed the option for acute reversal of anticoagulation.
10.1016/j.bpa.2020.06.002
American Society of Hematology 2021 guidelines for management of venous thromboembolism: prevention and treatment in patients with cancer.
Blood advances
BACKGROUND:Venous thromboembolism (VTE) is a common complication among patients with cancer. Patients with cancer and VTE are at a markedly increased risk for morbidity and mortality. OBJECTIVE:These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in their decisions about the prevention and treatment of VTE in patients with cancer. METHODS:ASH formed a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. The guideline development process was supported by updated or new systematic evidence reviews. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess evidence and make recommendations. RESULTS:Recommendations address mechanical and pharmacological prophylaxis in hospitalized medical patients with cancer, those undergoing a surgical procedure, and ambulatory patients receiving cancer chemotherapy. The recommendations also address the use of anticoagulation for the initial, short-term, and long-term treatment of VTE in patients with cancer. CONCLUSIONS:Strong recommendations include not using thromboprophylaxis in ambulatory patients receiving cancer chemotherapy at low risk of VTE and to use low-molecular-weight heparin (LMWH) for initial treatment of VTE in patients with cancer. Conditional recommendations include using thromboprophylaxis in hospitalized medical patients with cancer, LMWH or fondaparinux for surgical patients with cancer, LMWH or direct oral anticoagulants (DOAC) in ambulatory patients with cancer receiving systemic therapy at high risk of VTE and LMWH or DOAC for initial treatment of VTE, DOAC for the short-term treatment of VTE, and LMWH or DOAC for the long-term treatment of VTE in patients with cancer.
10.1182/bloodadvances.2020003442
Management of venous thromboembolism in cancer patients: Considerations about the clinical practice guideline update of the American society of clinical oncology.
European journal of internal medicine
The American Society of Clinical Oncology (ASCO) recently updated their clinical practice guidelines. The most novel aspect of this update is represented by the introduction of DOACs as pharmacological options both for prophylaxis and treatment of VTE in patients with cancer. The heterogeneity of the cancer population in terms of type and stage of the malignancy, presence of comorbidities, and variability in cancer treatments and prognosis represent the major challenge of managing VTE in patients with cancer. The use of VTE prophylaxis is currently recommended in cancer patients admitted to the hospital for an acute illness or reduced mobility, but no sufficient information is available on the risk of bleeding during thromboprophylaxis. Concerning the thromboprophylaxis in ambulatory cancer patients receiving chemotherapy, further refinement of existing risk models or development of new models are needed for improving risk stratification to identify high-risk cancer patients. The updated ASCO guidelines recommend the use of DOACs (edoxaban and rivaroxaban) for treatment of VTE in patients with cancer. However, Major concerns on "real-life" use of DOACs in patients with cancer are highlighted especially for the bleeding risk in patients with gastrointestinal cancers and the potential drug-drug interactions with specific anticancer therapies. CONCLUSIONS: Uncertainties to the updated ASCO guidelines remain concerning a number of indications on prophylaxis and treatment due to the limited evidence available. These limitations determine the low strength of the recommendations. The ongoing studies will contribute to refine the best management of patients with cancer-associated VTE.
10.1016/j.ejim.2019.10.033
Guidelines in Practice: Prevention of Venous Thromboembolism.
AORN journal
Venous thromboembolism (VTE), a condition involving deep vein thrombosis and embolism, can cause death when left untreated. Hospitalized patients and those who have recently undergone surgery or have a cancer diagnosis are at increased risk for VTE development. The updated AORN "Guideline for prevention of venous thromboembolism" provides perioperative nurses with a variety of evidence-based recommendations associated with the topic. This article provides an overview of the guideline and discusses recommendations for a VTE protocol, VTE and bleeding risk assessments, pharmacologic and mechanical VTE prophylaxis, postoperative ambulation, and patient and family education. It also includes a scenario that illustrates the importance of the VTE assessment and the use of mechanical prophylaxis for high-risk patients undergoing operative or other invasive procedures. Perioperative nurses should review the guideline in its entirety and implement recommendations in operative and procedural settings.
10.1002/aorn.14019