Pharmacological prophylaxis vs no prophylaxis Extended-duration DOACs vs shorter-duration non-DOAC prophylaxisĮxtended-duration outpatient prophylaxis vs inpatient-only prophylaxisĬhronically ill patients or nursing home patientsġ5. Intermittent pneumatic compression stockings vs graduated compression stockingsġ2. Mechanical combined with pharmacological vs pharmacological aloneġ0. Mechanical combined with pharmacological vs mechanical aloneĩ. Mechanical vs pharmacological prophylaxisĨ. Fondaparinux vs low molecular weight heparin or unfractionated heparinĬritically ill patients: pharmacological prophylaxis addressing the following comparisonsĪcutely or critically ill patients: mechanical prophylaxis addressing the following comparisonsĦ. Parenteral anticoagulant vs no parenteral anticoagulantģ. Renal failure (GFR 30-59 vs ≥60 mL/min per m 2)Īcutely ill patients: pharmacological prophylaxis addressing the following comparisonsġ. IMPROVE bleeding RAM: score ≥7 indicates high bleeding risk ¶ IMPROVE VTE RAM: score ≥2 indicates increased VTE risk † Previous VTE (excluding superficial thrombophlebitis)Īcute myocardial infarction or ischemic strokeĪcute infection and/or rheumatologic disorder Padua VTE RAM: score ≥4 indicates high VTE risk * 2-7 Description of the target populations 22 Other medical populations that may be at increased risk for VTE include long-term care residents, frail persons, those with minor injuries, and long-distance travelers, particularly those with preexisting VTE risk factors. 21 The increased risk of VTE persists for 45 to 60 days after hospital discharge. 20 In a United States population-based study, hospital-acquired DVT and PE occurred in 1.3% and 0.4% of hospital admissions, respectively. 19 Almost all hospitalized patients have ≥1 risk factor for VTE, and ∼40% have ≥3 risk factors. Risk factors for hospital-acquired VTE include acute medical illness, surgery, cancer and cancer therapy, trauma, immobilization, central venous catheters, previous history of VTE, older age, and obesity.
2,3 Thus, hospitalization for acute medical illness is an important opportunity for applying prevention efforts. About 50% of all VTE events in the community occur as a result of a current or recent hospital admission, mainly for surgery (24%) or acute medical illness (22%). VTE in hospitalized and nonhospitalized medical patients and long-distance travelers confers an important disease burden and can be fatal. An evaluation of the conditions and criteria (and the related judgments, research evidence, and additional considerations) that determined the conditional (rather than strong) recommendation will help to identify possible research gaps.
Performance measures about the suggested course of action should focus on whether an appropriate decision-making process is duly documented.įor researchers: this recommendation is likely to be strengthened (for future updates or adaptation) by additional research. Decision aids may be useful in helping individuals to make decisions consistent with their individual risks, values, and preferences.įor policy makers: policy making will require substantial debate and involvement of various stakeholders. Decision aids may be useful in helping patients to make decisions consistent with their individual risks, values, and preferences.įor clinicians: different choices will be appropriate for individual patients, and clinicians must help each patient arrive at a management decision consistent with the patient's values and preferences.
For patients: the majority of individuals in this situation would want the suggested course of action, but many would not.
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