ACP recommends new approach to prevent venous thromboembolism in hospitalized patients

In a new clinical practice guideline published today in Annals of Internal Medicine, the American College of Physicians (ACP) recommends that doctors assess the risk of thromboembolism and bleeding in patients hospitalized for medical illnesses, including stroke, before initiating therapy to prevent venous thromboembolism (VTE).

VTE, comprised of (PE) and (DVT), is a serious, common clinical problem. Because most hospitalized patients have at least one VTE risk factor, many hospitals routinely give patients blood thinners. However, these medications increase the risk of bleeding.

"The evidence does not support routine VTE prophylaxis in patients hospitalized for medical illnesses, including stroke," said Amir Qaseem, MD, FACP, PhD, MHA, Director of Clinical Policy at ACP. "If a patient is at risk for VTE, the American College of Physicians recommends that physicians prescribe heparin or related blood thinners, unless the assessed risk of bleeding outweighs likely benefits."

Benefits and Risks of Blood Thinners and Mechanical Devices

In patients hospitalized for medical illnesses, including stroke, prevention with heparin is associated with a statistically significant reduction in PE events. In most cases, the of reducing PE events will outweigh the harm of increased risk of bleeding events, the guideline states. No differences in benefits or harms were found between the types of used.

If a patient is at risk for VTE and bleeding from blood thinners, ACP does not recommend using graduated compression stockings. The evidence showed that they were not effective in preventing VTE or reducing death, and resulted in clinically important lower extremity .

ACP's recommendations do not apply to patients hospitalized for surgery.

ACP Does Not Support Performance Measures that Encourage Routine VTE Prevention

The guideline also includes a Policy Implication statement against hospital performance measures that promote universal VTE prevention regardless of a patient's individual risks for VTE and bleeding.

"Because there is no standard, accepted risk-assessment formula to identify which nonsurgical patients are likely to benefit from VTE prophylaxis, this is best left to physician judgment and performance measures encouraging routine prevention in all patients are inappropriate," said Dr. Qaseem. "Until we can better identify those patients who truly benefit, performance measures that encourage VTE prophylaxis for patients hospitalized for medical illnesses, including stroke, may encourage physicians to use prevention in low risk patients for whom the risks may exceed the benefit."

Venous Thromboembolism

In VTE, blood clots often form in leg veins (DVT). Pieces of these leg clots can break off and travel to the lungs, causing a serious condition called pulmonary embolism. A large embolism may result in acute heart failure or sudden death.

Twenty-six percent of patients with undiagnosed and untreated PE will have a subsequent fatal embolism, and another 26 percent will have a non-fatal recurrent embolism. Studies show that between 5 and 10 percent of all in-hospital deaths are a direct result of PE. The incidence of PE in the United States accounts for 200,000 to 300,000 hospitalizations per year.

Provided by American College of Physicians

not rated yet
add to favorites email to friend print save as pdf

Related Stories

Recommended for you

Surrogate offers clues into man with 16 babies

6 hours ago

When the young Thai woman saw an online ad seeking surrogate mothers, it seemed like a life-altering deal: $10,000 to help a foreign couple that wanted a child but couldn't conceive.

Nurses go on strike in Ebola-hit Liberia

6 hours ago

Nurses at Liberia's largest hospital went on strike on Monday, demanding better pay and equipment to protect them against a deadly Ebola epidemic which has killed hundreds in the west African nation.

ALS Ice Bucket Challenge arrives in North Korea

Aug 31, 2014

It's pretty hard to find a novel way to do the ALS Ice Bucket Challenge by now, but two-time Grammy-winning rapper Pras Michel, a founding member of the Fugees, has done it—getting his dousing in the center ...

Cold cash just keeps washing in from ALS challenge

Aug 28, 2014

In the couple of hours it took an official from the ALS Association to return a reporter's call for comment, the group's ubiquitous "ice bucket challenge" had brought in a few million more dollars.

Medtronic spends $350M on another European deal

Aug 27, 2014

U.S. medical device maker Medtronic is building stronger ties to Europe, a couple months after announcing a $42.9 billion acquisition that involves moving its main executive offices across the Atlantic, where it can get a ...

User comments