This is the current release of the guideline.

This guideline updates a previous version: Practice parameters for the prevention of venous thromboembolism. The Standards Task Force of the American Society of Colon and Rectal Surgeons. Dis Colon Rectum 2000 Aug;43(8):1037-47.

The levels of evidence (I-V) and the grades of recommendations (A-D) are defined at the end of the "Major Recommendations" field.

Treatment Recommendations

1. Patients undergoing anorectal procedures who are younger than 40 years of age and have no additional risk factors (see Table 1 in the original guideline document for a list of risk factors) for venous thromboembolism (VTE) require no specific prophylaxis. Level of Evidence: V; Grade of Recommendation: D
2. Patients undergoing anorectal procedures who are older than 40 and/or have additional risk factors for VTE should be considered for prophylaxis on a case-by-case basis. Level of Evidence: V; Grade of Recommendation: D

   Patients in the moderate-risk to high-risk group (see original guideline document for a description of each of the four risk categories: low-risk, moderate-risk, high-risk, and highest risk) are appropriately considered for prophylaxis based on the number of risk factors, the length and magnitude of the planned surgery, and the risk of bleeding. The appropriate means of prophylaxis would be mechanical compression or heparin (low-dose unfractionated heparin [LDUH] or low-molecular-weight heparin [LMWH]). Because of the frequent outpatient nature of this type of surgery and the potential for bleeding in many anorectal procedures, mechanical prophylaxis may be preferable in most cases.

3. Patients in the moderate-risk to high-risk categories for VTE undergoing abdominal surgery should receive prophylaxis with LDUH or LMWH. Patients at risk for bleeding may receive mechanical prophylaxis instead. Level of Evidence: I; Grade of Recommendation: A

   Mechanical methods may be chosen in patients in whom the risk of bleeding is judged to outweigh the benefit of prophylactic heparin.

4. Patients in the highest-risk category for VTE should receive both mechanical and heparin prophylaxis. Level of Evidence: I; Grade of Recommendation: A

   In this high-risk group, mechanical prophylaxis adds further protection compared with heparin alone.

5. Patients undergoing laparoscopic colorectal procedures should receive VTE prophylaxis according to the same risk assessment that would be applicable for the same surgery performed as an open procedure. Level of Evidence: V; Grade of Recommendation: D
6. Patients who have undergone major cancer surgery may benefit from posthospital prophylaxis with LMWH. Level of Evidence: II; Grade of Recommendation: C

   The optimum duration of VTE prophylaxis is currently unknown. Although most deep vein thrombosis (DVT) occurs within the first week or two after surgery, VTE complications, including pulmonary embolism (PE), can occur beyond that time frame. These findings combined with shrinking hospital stays have generated an interest in the appropriate duration of VTE prophylaxis. There is evidence that in cancer-surgery patients, continued prophylaxis for two to three weeks after discharge reduces the incidence of asymptomatic DVT.

Definitions

Levels of Evidence

1. Meta-analysis of multiple well-designed, controlled studies; randomized trials with low false-positive and low false-negative errors (high power)
2. At least one well-designed experimental study; randomized trials with high false-positive or high false-negative errors or both (low power)
3. Well-designed, quasi-experimental studies, such as nonrandomized, controlled, single-group, preoperative-postoperative comparison, cohort, time, or matched case-control series
4. Well-designed, nonexperimental studies, such as comparative and correlational descriptive and case studies
5. Case reports and clinical examples

Grades of Recommendations

1. Evidence of Type I or consistent findings from multiple studies of Type II, III, or IV
2. Evidence of Type II, III, or IV and generally consistent findings
3. Evidence of Type II, III, or IV but inconsistent findings
4. Little or no systematic empirical evidence

None provided

The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations" field).

Not applicable: The guideline was not adapted from another source.

2000 Aug (revised 2006 Oct)

American Society of Colon and Rectal Surgeons - Medical Specialty Society

American Society of Colon and Rectal Surgeons

Standards Practice Task Force of the American Society of Colon and Rectal Surgeons

Authors: Thomas J. Stahl, MD; Sharon G. Gregorcyk, MD; Neil H. Hyman, MD; W. Donald Buie, MD; and the Standards Practice Task Force of The American Society of Colon and Rectal Surgeons (ASCRS)

Contributing Members of the ASCRS Standards Committee: Amir L. Bastawrous, MD; Gary D. Dunn, MD; C. Neal Ellis, MD; Phillip R. Fleshner, MD; Clifford Y. Ko, MD; Nancy A. Morin, MD; Richard L. Nelson, MD; Graham L. Newstead, MD; Jason R. Penzer, MD; W. Brian Perry, MD; Janice F. Rafferty, MD; Paul C. Shellito, MD; Charles A. Ternent, MD; Joe J. Tjandra, MD

Not stated

This is the current release of the guideline.

This guideline updates a previous version: Practice parameters for the prevention of venous thromboembolism. The Standards Task Force of the American Society of Colon and Rectal Surgeons. Dis Colon Rectum 2000 Aug;43(8):1037-47.

None available

None available

This summary was completed by ECRI on February 13, 2001. The information was verified by the guideline developer on May 9, 2002. This NGC summary was updated by ECRI Institute on May 30, 2007. This summary was updated by ECRI Institute on March 14, 2008 following the updated FDA advisory on heparin sodium injection.

American Society of Colon and Rectal Surgeons (ASCRS) parameters may be downloaded for personal use (one copy); copies for other purposes, please contact the ASCRS office at (847) 290-9184.