Prevention of venous thromboembolism in patients admitted to Australian hospitals: summary of National Health and Medical Research Council clinical practice guideline

Abstract

Each year in Australia, about 1 in 1000 people develop a first episode of venous thromboembolism (VTE), which approximates to about 20 000 cases. More than half of these episodes occur during or soon after a hospital admission, which makes them potentially preventable. This paper summarises recommendations from the National Health and Medical Research Council's 'Clinical Practice Guideline for the Prevention of Venous Thromboembolism in Patients Admitted to Australian Hospitals' and describes the way these recommendations were developed. The guideline has two aims: to provide advice on VTE prevention to Australian clinicians and to support implementation of effective programmes for VTE prevention in Australian hospitals by offering evidence-based recommendations which local hospital guidelines can be based on. Methods for preventing VTE are pharmacological and/or mechanical, and they require appropriate timing, dosing and duration and also need to be accompanied by good clinical care, such as promoting mobility and hydration whilst in hospital. With some procedures or injuries, the risk of VTE is sufficiently high to require that all patients receive an effective form of prophylaxis unless this is contraindicated; in other clinical settings, the need for prophylaxis requires individual assessment. For optimal VTE prevention, all patients admitted to hospital should have early and formal assessments of: (i) their intrinsic VTE risk and the risks related to their medical conditions; (ii) the added VTE risks resulting from surgery or trauma; (iii) bleeding risks that would contraindicate pharmacological prophylaxis; (iv) any contraindications to mechanical prophylaxis, culminating in (v) a decision about prophylaxis (pharmacological and/or mechanical, or none). The most appropriate form of prophylaxis will depend on the type of surgery, medical condition and patient characteristics. Recommendations for various clinical circumstances are provided as summary tables with relevance to orthopaedic surgical procedures, other types of surgery and medical inpatients. In addition, the tables indicate the grades of supporting evidence for the recommendations (these range from Grade A which can be trusted to guide practice, to Grade D where there is more uncertainty; Good Practice Points are consensus-based expert opinions).

Prevention of Venous Thromboembolism, 2nd Edition: Korean Society of Thrombosis and Hemostasis Evidence-Based Clinical Practice Guidelines

“…Furthermore, data from numerous clinical trials have demonstrated that appropriate prophylaxis to prevent VTE is safe and effective in both surgical and medical patients. Based on these results, several evidence-based guidelines have been proposed for VTE prevention (5-8). Recently, the American College of Chest Physicians (ACCP) issued the evidence-based clinical practice guideline for antithrombotic therapy and prevention of thrombosis, which provides improved guidelines in an American setting (9th edition) (6).…”

Incidence and risk factors of venous thromboembolism after pelvic uro‐oncologic surgery – a single center experience

“…Due to insufficient evidence and heterogeneity of patients included in clinical trials, the current National Health and Medical Research Council (NHMRC) VTE clinical practice guideline fails to provide explicit thromboprophylaxis recommendations for urological surgery, instead leaving it to the discretion of the treating physician [16]. Nevertheless our study demonstrated a high rate of thromboprophylaxis with 98% of patients having had mechanical prophylaxis and 97.7% of patients prescribed pharmacological prophylaxis during their hospital stay.…”

Primary prevention and treatment of venous thromboembolic events in patients with gastrointestinal cancers - Review

“…In the American guidelines (ASCO, NCCN) [19,34] , extended prophylaxis is only recommended in the presence of high thromboembolic risk factors such as residual or advanced cancer, aged 60 or older, obesity, previous history of VTE, duration of surgery longer than 2 h or prolonged postoperative immobilization. In patients with contraindications to pharmacological anticoagulant prevention strategies (e.g., increased risk of hemorrhage), the use of intermittent pneumatic compression devices or compression stockings is advised [19][20][21][22][23][24][25][26][27] . The recommendations for patients undergoing minimally invasive or laparoscopic surgery are even less evidence-based.…”

“…Acute thrombosis of splanchnic veins -PVT in particularis a frequent complication in patients with cancers of the hepato-biliary-pancreatic system [23,85] . PVT results in portal hypertension and impairment of liver perfusion.…”

“…Recommendations for patients with malignancies are therefore based on the sparse available evidence and the guidelines differ only marginally (Table 2) [19][20][21][22][23][24][25][26][27] . Most clinical studies focusing on VTE in cancer patients do not differentiate between different kinds of cancer, resulting in a lack of specific data concerning VTE in gastrointestinal cancers.…”