European Guidelines on perioperative venous thromboembolism prophylaxis

Afshari, Arash; Ageno, Walter; Ahmed, Aamer; Duranteau, Jacques; Faraoni, David; Kozek‐Langenecker, Sibylle A.; Llau, Juan V.; Nizard, J.; Solca, M; Stensballe, Jakob; Thienpont, Emmanuel; Tsiridis, Eleftherios; Venclauskas, Linas; Samama, Charles Marc

doi:10.1097/eja.0000000000000729

Cited by 128 publications

(91 citation statements)

References 12 publications

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“…Experimental data support this proposition to some degree, and evidence in humans suggests that antiplatelet drugs do decrease the risk of venous thrombosis . However, this should be viewed in the context of the substantial body of evidence in humans supporting administration of anticoagulants as first line prophylactic drugs for venous thrombosis …”

Section: Results and Recommendationsmentioning

confidence: 99%

ACVIM consensus statement on the treatment of immune‐mediated hemolytic anemia in dogs

Swann

Garden

Fellman

et al. 2019

Veterinary Internal Medicne

187

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Immune‐mediated hemolytic anemia (IMHA) causes severe anemia in dogs and is associated with considerable morbidity and mortality. Treatment with various immunosuppressive and antithrombotic drugs has been described anecdotally and in previous studies, but little consensus exists among veterinarians as to the optimal regimen to employ and maintain after diagnosis of the disease. To address this inconsistency and provide evidence‐based guidelines for treatment of IMHA in dogs, we identified and extracted data from studies published in the veterinary literature. We developed a novel tool for evaluation of evidence quality, using it to assess study design, diagnostic criteria, explanation of treatment regimens, and validity of statistical methods. In combination with our clinical experience and comparable guidelines for humans afflicted with autoimmune hemolytic anemia, we used the conclusions of this process to make a set of clinical recommendations regarding treatment of IMHA in dogs, which we refined subsequently by conducting several iterations of Delphi review. Additionally, we considered emerging treatments for IMHA in dogs and highlighted areas deserving of future research. Comments were solicited from several professional bodies to maximize clinical applicability before the recommendations were submitted for publication. The resulting document is intended to provide clinical guidelines for management of IMHA in dogs. These guidelines should be implemented pragmatically, with consideration of animal, owner, and veterinary factors that may vary among cases.

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Section: Results and Recommendationsmentioning

confidence: 99%

ACVIM consensus statement on the treatment of immune‐mediated hemolytic anemia in dogs

Swann

Garden

Fellman

et al. 2019

Veterinary Internal Medicne

187

View full text Add to dashboard Cite

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“…In human medicine, multiple iterations of evidence‐based guidelines for the management of venous and arterial thrombosis have been published . These guidelines are based on a wealth of high‐quality evidence resulting from large‐scale randomized controlled trials .…”

Section: Introductionmentioning

confidence: 99%

American College of Veterinary Emergency and Critical Care (ACVECC) Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE) guidelines: Small animal

Goggs

Blais

Brainard

et al. 2019

J Vet Emergen Crit Care

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Objectives: To systematically review available evidence and establish guidelines related to the risk of developing thrombosis and the management of small animals with antithrombotics. Design: Standardized, systematic evaluation of the literature (identified by searching Medline via PubMed and CAB abstracts) was carried out in 5 domains (Defining populations at risk; Defining rational therapeutic use; Defining evidence-based protocols; Refining and monitoring antithrombotic therapies; and Discontinuing antithrombotic therapies). Evidence evaluation was carried out using Population, Intervention, Comparison, Outcome generated within each domain questions to address specific aims. This was followed by categorization of relevant articles according to level of evidence and quality (Good, Fair, or Poor). Synthesis of these data led to the development of a series of statements. Consensus on the final guidelines was achieved via Delphi-style surveys.Draft recommendations were presented at 2 international veterinary conferences and made available for community assessment, review, and comment prior to final revisions and publication. Settings: Academic and referral veterinary medical centers.Results: Over 500 studies were reviewed in detail. Worksheets from all 5 domains generated 59 statements with 83 guideline recommendations that were refined during 3 rounds of Delphi surveys. A high degree of consensus was reached across all guideline recommendations. Conclusions:Overall, systematic evidence evaluations yielded more than 80 recommendations for the treatment of small animals with or at risk of developing thrombosis. Numerous significant knowledge gaps were highlighted by the evidence reviews undertaken, indicating the need for substantial additional research in this field. K E Y W O R D S ) for their dedicated contributions to this effort. We would also like to thank the members of the veterinary community who attended and contributed to the discussion of the guidelines during the 2018 EVECC Congress and IVECCS sessions and subsequently during the online open-comment stages. CONFLICT OF INTERESTThe authors declare that they have no conflicts of interest.

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“…Some older studies (primarily the Pulmonary Embolism Prevention [PEP] trial) suggested that aspirin used for 35 days was effective for VTE prophylaxis in hip fracture and patients undergoing THA, when compared to placebo. In the 2012 ACCP guidelines and 2018 European guidelines, aspirin was among the recommended (Grade 1B) pharmacologic prophylaxis options for patients undergoing THA, TKA, and hip fracture surgery, compared to no pharmacologic prophylaxis. However, how does aspirin compare to anticoagulant prophylaxis, a more relevant comparison?…”

Section: Role Of Aspirin For Vte Prophylaxis In Major Orthopedic Surgerymentioning

confidence: 99%

What’s new in VTE risk and prevention in orthopedic surgery

Kahn

Shivakumar

2020

Research and Practice in Thrombosis and Haemostasis

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A State of the Art lecture titled “What’s New in VTE Risk and Prevention in Orthopedic Surgery” was presented at the ISTH congress in 2019. Patients undergoing orthopedic surgery have long been recognized to be at increased risk of venous thromboembolism (VTE) and were among the first patient groups to be studied in VTE prophylaxis trials. From the late 1950s to 2010s, prophylaxis trials in major orthopedic surgery tended to focus on venographic deep vein thrombosis and assessed thromboprophylaxis in all patients based on a population approach. In general, anticoagulants were favored over mechanical prophylaxis or aspirin, and longer‐duration prophylaxis was favored over shorter durations. As discussed in this paper, more recently, orthopedic prophylaxis has started to become more nuanced and individualized. Modern trials are focusing on symptomatic VTE as outcomes; there has been a resurgence in interest in aspirin for prophylaxis, and there has been a slow move to studying ways to evaluate VTE risk in patients undergoing orthopedic surgery and recommending thromboprophylaxis to patients based on individual attributes, in whom risk stratification and weighing of benefit versus risk of thromboprophylaxis is becoming key. We also touch on VTE risk and guideline recommendations to prevent VTE in 2 other commonly encountered orthopedic populations: patients undergoing knee arthroscopy and those with distal leg fractures. Finally, we summarize relevant new data on this topic presented during the 2019 ISTH annual congress in Melbourne.

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European Guidelines on perioperative venous thromboembolism prophylaxis

Cited by 128 publications

References 12 publications

ACVIM consensus statement on the treatment of immune‐mediated hemolytic anemia in dogs

ACVIM consensus statement on the treatment of immune‐mediated hemolytic anemia in dogs

American College of Veterinary Emergency and Critical Care (ACVECC) Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE) guidelines: Small animal

What’s new in VTE risk and prevention in orthopedic surgery

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