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News

The 9th edition of the American College of Chest Physicians Evidence-Based Clinical Practice Guidelines on Antithrombotic Therapy and Prevention of Thrombosis were published in February 2012. Read more
Significant changes, regarding VTE, to this edition include: (click to expand)
- Changes in methodology and evidence interpretation, leading to weaker recommendations than in the past.
- New chapters added include: DVT Diagnosis and Patient Values & Preferences. The VTE Prevention chapter is now divided into 3 chapters: VTE Prevention in Non-Surgical Patients, VTE Prevention in Non-Orthopedic Surgery, and VTE Prevention in Orthopedic Surgery.
- Aspirin is given an ‘IB’ recommendation as a pharmacological agent for VTE prophylaxis in orthopedic surgery patients.
- Low dose aspirin, fondaparinux, or mechanical prophylaxis is recommended for VTE prophylaxis in non-orthopedic surgical patients who are at high risk AND for whom LMWH and UFH are contraindicated or unavailable.
- Updated risk stratification in non-orthopedic surgery patients to assess thrombosis and bleeding risk.
- 'IB' recommendation against VTE prophylaxis in low risk medical patients.
- When LMWH is used to treat patients with acute DVT of the leg, a once daily dosing regimen is recommended over twice daily.
- For patients on VKA therapy with consistently stable INRs, INR testing frequency up to 12 weeks is recommended over every 4 weeks.

The American College of Physicians published a new practice guideline based on a meta-analysis conducted on the effects of VTE prophylaxis on mortality in nonsurgical, hospitalized patients. Results concluded that although heparin prophylaxis decreases PE rates, it does not reduce mortality and increases bleeding events. Therefore, the guideline recommends that risk-benefit assessment should be conducted for every hospitalized medical patient prior to automatically receiving VTE prophylaxis. Read more
The FDA Office of Surveillance & Epidemiology released a report on a retrospective cohort study that was conducted in over 835,000 women to evaluate the thromboembolic risks of new combined hormonal contraceptive products. The results found that drospirenone/ethinyl estradiol tablets, norelgestromin/ethinyl estradiol transdermal patch and etonogestrel/estradiol vaginal ring are all associated with increased VTE risk. Read more

VTE Prevention Resources

The Surgeon General’s Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism. 2008.	Preventing Hospital-Acquired Venous Thromboembolism: A Guide for Effective Quality Improvement. Agency for Healthcare Research and Quality. 2008.
Health Services Advisory Group VTE Guide for Executive Leadership	Society of Hospital Medicine Venous Thromboembolism Resource Room

Guidelines/Consensus Statements

Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. 2012. Full Text Guidelines	American Society of Clinical Oncology Guideline: Recommendations for Venous Thromboembolism Prophylaxis and Treatment in Patients with Cancer. 2007. Full Text Guidelines
Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Third Edition) Full Text Guidelines	American Academy of Orthopedic Surgeons: Preventing Venous Thromboembolic Disease in Patients Undergoing Elective Hip and Knee Arthroplasty. 2011. Full Text Guidelines
Delivery of Optimized Anticoagulant Therapy: Consensus Statement from the Anticoagulation Forum 2008 Full Text Article	Institute for Clinical Systems Improvement: Antithrombotic Therapy Supplement. 2011. Full Text Guidelines
American College of Obstetricians and Gynecologists Practice Bulletin: Prevention of DVT and PE. 2007. Full Text Guidelines (Subscription Required)	American College of Obstetricians and Gynecology Practice Bulletin: Thromboembolism in Pregnancy – update includes Cesarean Deliveries. 2011. Full Text Guidelines (Subscription Required)

Standards/ Performance Measures

National Consensus Standards for Prevention and Care of Venous Thromboembolism
Joint project between The Joint Commission and the National Quality Forum (NQF), initiated in 2004, to develop and standardize performance measures for the prevention and care of venous thromboembolism.

Surgical Care Improvement Project
The Surgical Care Improvement Project (SCIP) is a national quality partnership of organizations focused on improving surgical care by significantly reducing surgical complications. SCIP targets four areas, including deep vein thrombosis (DVT). The SCIP measures are included in The Joint Commission Specifications Manual for National Hospital Inpatient Quality Measures.

Useful Web Sites

The Anticoagulation Forum The Anticoagulation Forum is a multidisciplinary nonprofit organization of health care professionals that will improve the quality of care for patients taking antithrombotic medications.	ASHP Anticoagulation Resource Center The American Society of Health-System Pharmacists' on-line resource center is a compilation of anticoagulation materials selected to assist practitioners in managing patient anticoagulation.
Clotblog Samuel Z Goldhaber, MD, Director, Venous Thromboembolism Research Group and Co-Director, Anticoagulation Management Service at Brigham and Women's Hospital maintains a video “ClotBlog”, posting weekly entries on up-to-date topics in antithrombotic therapy.	ClotCare Online Resource ClotCare strives to help others improve lives by providing both patients and healthcare providers with the most up-to-date information and expert insight on optimal use of antithrombotic and anticoagulant therapy.
Coalition to Prevent Deep-Vein Thrombosis The Coalition to Prevent Deep-Vein Thrombosis is a group of more than 60 organizations who have joined the Coalition in a united effort to raise awareness of DVT among consumers, healthcare professionals, policy-makers and public health leaders.	European Thrombosis Research Organization The European Thrombosis Research Organization is an international non-profit organization, that aims to promote education and scientific research on all aspects of thrombosis and haemostasis.
International Society on Thrombosis and Haemostasis The International Society on Thrombosis and Haemostasis is a worldwide organization dedicated to the advancement of understanding, prevention, diagnosis and treatment of thrombotic and bleeding disorders.	National Blood Clot Alliance The National Blood Clot Alliance (NBCA) is a patient-led, voluntary health advocacy organization. NBCA programs include patient education and professional training on the signs, symptoms, and prevention of blood clots and clotting disorders.
North American Thrombosis Forum The North American Thrombosis Forum (NATF) is a multi-disciplinary organization founded with the objective of improving patient care through the advancement of thrombosis education.	University of Washington Medicine Department of Pharmacy Anticoagulation Services shares their anticoagulation guidelines and protocols.
Venous Disease Coalition The goal of the Venous Disease Coalition is to disseminate science-based information about venous disease to the public and healthcare professionals with the hope of empowering people to protect themselves and their family members from venous disease.