CHEST-2012 Prevention for Nonsurgical patients Flashcards
Recommended prophylaxis options for hospitalized medical patients at increased risk of thrombosis
For acutely ill hospitalized medical patients
at increased risk of thrombosis (Table 2), we
recommend anticoagulant thromboprophylaxis
With LMWH, LDUH bid, LDUH tid, or fondaparinux
(Grade 1B) .
Should you use VTE prophylaxis for acutely ill patients with low risk of thrombosis?
No
For acutely ill hospitalized medical patients
at low risk of thrombosis (Table 2), we recommend
against the use of pharmacologic prophylaxis
or mechanical prophylaxis (Grade 1B)
Should you anticoagulate an acutely ill patient who is bleeding or high risk of bleed?
No.
For acutely ill hospitalized medical
patients who are bleeding or at high risk for
bleeding (Table 3), we recommend against anticoagulant
thromboprophylaxis (Grade 1B)
Can you use mechanical prophylaxis for an acutely ill patient who is bleeding or high risk of bleed but also at increased risk of thrombosis?
Yes.
For acutely ill hospitalized medical
patients at increased risk of thrombosis who are
bleeding or at high risk for major bleeding,
we suggest the optimal use of mechanical
thromboprophylaxis with GCS (Grade 2C) or
IPC (Grade 2C) , rather than no mechanical thromboprophylaxis.
When bleeding risk decreases,
and if VTE risk persists, we suggest that
pharmacologic thromboprophylaxis be substituted
for mechanical thromboprophylaxis
(Grade 2B) .
How long should thromboprophylaxis last for an acutely ill hospitalized patient?
Only during the period of immobilization or acute hospital stay–do not extend duration longer than this.
In acutely ill hospitalized medical patients
who receive an initial course of thromboprophylaxis,
we suggest against extending the duration
of thromboprophylaxis beyond the period of patient immobilization or acute hospital stay
(Grade 2B) .
Should you use routine ultrasound screening for DVT in critically ill patients?
No.
In critically ill patients, we suggest against
routine ultrasound screening for DVT (Grade 2C) .
Should you use thromboprophylaxis in critically ill patients? If so, with what?
Yes.
For critically ill patients, we suggest using
LMWH or LDUH thromboprophylaxis over no
prophylaxis (Grade 2C)
When should you use mechanical prophylaxis for critically ill patients?
Use mechanical when bleeding or high risk of bleed.
Switch to pharmacologic when bleed risk decreases
For critically ill patients who are bleeding,
or are at high risk for major bleeding (Table 4),
we suggest mechanical thromboprophylaxis with GCS (Grade 2C) or IPC (Grade 2C) until the
bleeding risk decreases, rather than no mechanical
thromboprophylaxis. When bleeding risk
decreases, we suggest that pharmacologic thromboprophylaxis
be substituted for mechanical
thromboprophylaxis (Grade 2C)
Should you use VTE prophylaxis in outpatients with cancer but no additional risk factors for VTE?
No.
In outpatients with cancer who have no
additional risk factors for VTE, we suggest
against routine prophylaxis with LMWH or
LDUH (Grade 2B) and recommend against the
prophylactic use of VKAs (Grade 1B) .
Remarks: Additional risk factors for venous thrombosis
in outpatients with cancer include previous venous
thrombosis, immobilization, hormonal therapy, angiogenesis inhibitors, thalidomide, and lenalidomide.
Should you use VTE prophylaxis in outpatients with solid tumors, additional risk factors for VTE, and low risk of bleed?
Yes. Use LMWH or LDUH
In outpatients with solid tumors who have
additional risk factors for VTE and who are at
low risk of bleeding, we suggest prophylacticdose
LMWH or LDUH over no prophylaxis
(Grade 2B) .
Remarks: Additional risk factors for venous thrombosis
in outpatients with cancer include previous venous
thrombosis, immobilization, hormonal therapy, angiogenesis
inhibitors, thalidomide, and lenalidomide.
Should you use VTE prophylaxis in outpatients with cancer and indwelling central venous catheter?
No.
In outpatients with cancer and indwelling
CVCs, we suggest against routine prophylaxis with
LMWH or LDUH (Grade 2B) and suggest against
the prophylactic use of VKAs (Grade 2C) .
Should you use VTE prophylaxis in an immobilized patient residing at home or nursing home?
No.
In chronically immobilized persons residing
at home or at a nursing home, we suggest
against the routine use of thromboprophylaxis
(Grade 2C) .
What 4 things do you suggest for long-distance travelers at increased risk of VTE?
Frequent ambulation, calf muscle exercise, sitting in an aisle seat, GCS
For long-distance travelers at increased risk
of VTE (including previous VTE, recent surgery or trauma, active malignancy, pregnancy, estrogen
use, advanced age, limited mobility, severe
obesity, or known thrombophilic disorder), we
suggest frequent ambulation, calf muscle exercise
or sitting in an aisle seat if feasible (Grade 2C) .
For long-distance travelers at increased
risk of VTE (including previous VTE, recent
surgery or trauma, active malignancy, pregnancy,
estrogen use, advanced age, limited
mobility, severe obesity, or known thrombophilic
disorder), we suggest use of properly fitted,
below-knee GCS providing 15 to 30 mm Hg of
pressure at the ankle stockings during travel
(Grade 2C) . For all other long-distance travelers,
we suggest against the use of GCS (Grade 2C) .
Should long-distance travelers use aspirin or anticoagulants for VTE prophylaxis?
No.
For long-distance travelers, we suggest against the use of aspirin or anticoagulants to prevent VTE (Grade 2C) .
Is VTE prophylaxis recommended for a person with asymptomatic thrombophilia?
No.
In persons with asymptomatic thrombophilia
(ie, without a previous history of VTE),
we recommend against the long-term daily use
of mechanical or pharmacologic thromboprophylaxis
to prevent VTE (Grade 1C) .
