ACP recommends new approach to prevent venous thromboembolism in hospitalized patients

October 31, 2011

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.

Explore further: Common vein condition increases risk for developing life-threating blood clots

Related Stories

Common vein condition increases risk for developing life-threating blood clots

August 17, 2011
Patients with clinically diagnosed superficial vein thrombosis (SVT), a blood clot in the veins just beneath the skin that commonly resolves on its own without treatment, are four to six times more likely to develop venous ...

Blood thinner may protect cancer patients from potentially fatal clots

June 7, 2011
A new type of anti-clotting drug called semuloparin has been found to reduce the development of potentially fatal blood clots in the veins that often occur in cancer patients, doctors at Duke Cancer Institute and elsewhere ...

Recommended for you

Female researchers pay more attention to sex and gender in medicine

November 7, 2017
When women participate in a medical research paper, that research is more likely to take into account the differences between the way men and women react to diseases and treatments, according to a new study by Stanford researchers.

Drug therapy from lethal bacteria could reduce kidney transplant rejection

August 3, 2017
An experimental treatment derived from a potentially deadly microorganism may provide lifesaving help for kidney transplant patients, according to an international study led by investigators at Cedars-Sinai.

Exploring the potential of human echolocation

June 25, 2017
People who are visually impaired will often use a cane to feel out their surroundings. With training and practice, people can learn to use the pitch, loudness and timbre of echoes from the cane or other sounds to navigate ...

Team eradicates hepatitis C in 10 patients following lifesaving transplants from infected donors

April 30, 2017
Ten patients at Penn Medicine have been cured of the Hepatitis C virus (HCV) following lifesaving kidney transplants from deceased donors who were infected with the disease. The findings point to new strategies for increasing ...

'bench to bedside to bench': Scientists call for closer basic-clinical collaborations

March 24, 2017
In the era of genome sequencing, it's time to update the old "bench-to-bedside" shorthand for how basic research discoveries inform clinical practice, researchers from The Jackson Laboratory (JAX), National Human Genome Research ...

The ethics of tracking athletes' biometric data

January 18, 2017
(Medical Xpress)—Whether it is a FitBit or a heart rate monitor, biometric technologies have become household devices. Professional sports leagues use some of the most technologically advanced biodata tracking systems to ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.