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. 2019 Dec 10;3(23):3898-3944.
doi: 10.1182/bloodadvances.2019000975.

American Society of Hematology 2019 guidelines for management of venous thromboembolism: prevention of venous thromboembolism in surgical hospitalized patients

David R Anderson  1 , Gian Paolo Morgano  2 , Carole Bennett  3 , Francesco Dentali  4 , Charles W Francis  5 , David A Garcia  6 , Susan R Kahn  7 , Maryam Rahman  8 , Anita Rajasekhar  9 , Frederick B Rogers  10 , Maureen A Smythe  11   12 , Kari A O Tikkinen  13   14 , Adolph J Yates  15 , Tejan Baldeh  2 , Sara Balduzzi  16 , Jan L Brożek  2   17 , Itziar Etxeandia- Ikobaltzeta  2 , Herman Johal  18 , Ignacio Neumann  19 , Wojtek Wiercioch  2 , Juan José Yepes-Nuñez  20 , Holger J Schünemann  2   17 , Philipp Dahm  21   22
Affiliations

American Society of Hematology 2019 guidelines for management of venous thromboembolism: prevention of venous thromboembolism in surgical hospitalized patients

David R Anderson et al. Blood Adv. .

Abstract

Background: Venous thromboembolism (VTE) is a common source of perioperative morbidity and mortality.

Objective: These evidence-based guidelines from the American Society of Hematology (ASH) intend to support decision making about preventing VTE in patients undergoing surgery.

Methods: ASH formed a multidisciplinary guideline panel balanced to minimize bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline-development process, including performing systematic reviews. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence and make recommendations, which were subject to public comment.

Results: The panel agreed on 30 recommendations, including for major surgery in general (n = 8), orthopedic surgery (n = 7), major general surgery (n = 3), major neurosurgical procedures (n = 2), urological surgery (n = 4), cardiac surgery and major vascular surgery (n = 2), major trauma (n = 2), and major gynecological surgery (n = 2).

Conclusions: For patients undergoing major surgery in general, the panel made conditional recommendations for mechanical prophylaxis over no prophylaxis, for pneumatic compression prophylaxis over graduated compression stockings, and against inferior vena cava filters. In patients undergoing total hip or total knee arthroplasty, conditional recommendations included using either aspirin or anticoagulants, as well as for a direct oral anticoagulant over low-molecular-weight heparin (LMWH). For major general surgery, the panel suggested pharmacological prophylaxis over no prophylaxis, using LMWH or unfractionated heparin. For major neurosurgery, transurethral resection of the prostate, or radical prostatectomy, the panel suggested against pharmacological prophylaxis. For major trauma surgery or major gynecological surgery, the panel suggested pharmacological prophylaxis over no prophylaxis.

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Conflict of interest statement

Conflict-of-interest disclosure: All authors were members of the guideline panel or of the systematic review team. As such, they completed a disclosure of interest form, which was reviewed by ASH and is available as Supplements 2 and 3.

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