This is the current release of the guideline.

This guideline updates a previous version: Geerts WH, Pineo GF, Heit JA, Bergqvist D, Lassen MR, Colwell CW, Ray JG. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004 Sep;126(3 Suppl):338S-400S.

The grades of recommendation (1A, 1B, 1C, 2A, 2B, 2C) are defined at the end of the "Major Recommendations" field.

General Recommendations

Hospital Thromboprophylaxis Policy

1. For every general hospital, the guideline developers recommend that a formal, active strategy that addresses the prevention of venous thromboembolism (VTE) be developed (Grade 1A).
2. The guideline developers recommend that the local thromboprophylaxis strategy be in the form of a written, institution-wide thromboprophylaxis policy (Grade 1C).
3. The guideline developers recommend the use of strategies shown to increase thromboprophylaxis adherence, including the use of computer decision support systems (Grade 1A), preprinted orders (Grade 1B), and periodic audit and feedback (Grade 1C). Passive methods such as distribution of educational materials or educational meetings are not recommended as sole strategies to increase adherence to thromboprophylaxis (Grade 1B).

Mechanical Methods of Thromboprophylaxis

1. The guideline developers recommend that mechanical methods of thromboprophylaxis be used primarily in patients at high risk of bleeding (Grade 1A), or possibly as an adjunct to anticoagulant-based thromboprophylaxis (Grade 2A).
2. For patients receiving mechanical methods of thromboprophylaxis, the guideline developers recommend that careful attention be directed toward ensuring the proper use of, and optimal adherence with, these methods (Grade 1A).

Aspirin as Thromboprophylaxis

The guideline developers recommend against the use of aspirin alone as thromboprophylaxis against VTE for any patient group (Grade 1A).

Anticoagulant Dosing

For each of the antithrombotic agents, the guideline developers recommend that clinicians follow manufacturer-suggested dosing guidelines (Grade 1C).

Renal Impairment and Anticoagulant Dosing

The guideline developers recommend that renal function be considered when making decisions about the use and/or the dose of low-molecular-weight heparin (LMWH), fondaparinux, and other antithrombotic drugs that are cleared by the kidneys, particularly in elderly patients, patients with diabetes mellitus, and those at high risk for bleeding (Grade 1A). Depending on the circumstances, the guideline developers recommend one of the following options in this situation: avoiding the use of an anticoagulant that bioaccumulates in the presence of renal impairment, using a lower dose of the agent, or monitoring the drug level or its anticoagulant effect (Grade 1B).

Antithrombotic Drugs and Neuraxial Anesthesia/Analgesia or Peripheral Nerve Blocks

1. For all patients undergoing neuraxial anesthesia or analgesia, the guideline developers recommend appropriate patient selection and caution when using anticoagulant thromboprophylaxis (Grade 1A).
2. For patients receiving deep peripheral nerve blocks, the guideline developers recommend that the same cautions considered for neuraxial techniques be applied when using anticoagulant thromboprophylaxis (Grade 1C).

General, Vascular, Gynecologic, Urologic, Laparoscopic, Bariatric, Thoracic, and Coronary Artery Bypass Surgery (CABG) Surgery

General Surgery

1. For low-risk general surgery patients who are undergoing minor procedures and have no additional thromboembolic risk factors, the guideline developers recommend against the use of specific thromboprophylaxis other than early and frequent ambulation (Grade 1A).
2. For moderate-risk general surgery patients who are undergoing a major procedure for benign disease, the guideline developers recommend thromboprophylaxis with LMWH, low-dose UFH (LDUH), or fondaparinux (each Grade 1A).
3. For higher-risk general surgery patients who are undergoing a major procedure for cancer, the guideline developers recommend thromboprophylaxis with LMWH, LDUH three times daily, or fondaparinux (each Grade 1A).
4. For general surgery patients with multiple risk factors for VTE who are thought to be at particularly high risk, the guideline developers recommend that a pharmacologic method (i.e., LMWH, LDUH three times daily, or fondaparinux) be combined with the optimal use of a mechanical method (i.e., graduated compression stockings [GCS] and/or intermittent pneumatic compression [IPC]) (Grade 1C).
5. For general surgery patients with a high risk of bleeding, the guideline developers recommend the optimal use of mechanical thromboprophylaxis with properly fitted GCS or intermittent pneumatic compression (IPC) (Grade 1A). When the high bleeding risk decreases, the guideline developers recommend that pharmacologic thromboprophylaxis be substituted for or added to the mechanical thromboprophylaxis (Grade 1C).
6. For patients undergoing major general surgical procedures, the guideline developers recommend that thromboprophylaxis continue until discharge from hospital (Grade 1A). For selected high-risk general surgery patients, including some of those who have undergone major cancer surgery or have previously had VTE, we suggest that continuing thromboprophylaxis after hospital discharge with LMWH for up to 28 days be considered (Grade 2A).

Vascular Surgery

1. For patients undergoing vascular surgery, who do not have additional thromboembolic risk factors, the guideline developers suggest that clinicians not routinely use specific thromboprophylaxis other than early and frequent ambulation (Grade 2B).
2. For patients undergoing major vascular surgery procedures who have additional thromboembolic risk factors, the guideline developers recommend thromboprophylaxis with LMWH, LDUH, or fondaparinux (Grade 1C).

Gynecologic Surgery

1. For low-risk gynecologic surgery patients who are undergoing minor procedures and have no additional risk factors, the guideline developers recommend against the use of specific thromboprophylaxis other than early and frequent ambulation (Grade 1A).
2. For gynecology patients undergoing entirely laparoscopic procedures, the guideline developers recommend against routine thromboprophylaxis, other than early and frequent ambulation (Grade 1B).
3. For gynecology patients undergoing entirely laparoscopic procedures in whom additional VTE risk factors are present, the guideline developers recommend the use of thromboprophylaxis with one or more of LMWH, LDUH, IPC, or GCS (Grade 1C).
4. For all patients undergoing major gynecologic surgery, the guideline developers recommend that thromboprophylaxis be used routinely (Grade 1A).
5. For patients undergoing major gynecologic surgery for benign disease, without additional risk factors, the guideline developers recommend LMWH (Grade 1A), LDUH (Grade 1A), or IPC started just before surgery and used continuously while the patient is not ambulating (Grade 1B).
6. For patients undergoing extensive surgery for malignancy, and for patients with additional VTE risk factors, the guideline developers recommend routine thromboprophylaxis with LMWH (Grade 1A), or LDUH three times daily (Grade 1A), or IPC, started just before surgery and used continuously while the patient is not ambulating (Grade 1A). Alternative considerations include a combination of LMWH or LDUH plus mechanical thromboprophylaxis with GCS or IPC, or fondaparinux (all Grade 1C).
7. For patients undergoing major gynecologic procedures, the guideline developers recommend that thromboprophylaxis continue until discharge from hospital (Grade 1A). For selected high-risk gynecology patients, including some of those who have undergone major cancer surgery or have previously had VTE, the guideline developers suggest that continuing thromboprophylaxis after hospital discharge with LMWH for up to 28 days be considered (Grade 2C).

Urologic Surgery

1. For patients undergoing transurethral or other low-risk urologic procedures, the guideline developers recommend against the use of specific thromboprophylaxis other than early and frequent ambulation (Grade 1A).
2. For all patients undergoing major, open urologic procedures, the guideline developers recommend that thromboprophylaxis be used routinely (Grade 1A).
3. For patients undergoing major, open urologic procedures, the guideline developers recommend routine thromboprophylaxis with LDUH twice daily or three times daily (Grade 1B), GCS, and/or IPC started just before surgery and used continuously while the patient is not ambulating (Grade 1B), LMWH (Grade 1C), fondaparinux (Grade 1C), or the combination of a pharmacologic method (i.e., LMWH, LDUH, or fondaparinux) with the optimal use of a mechanical method (i.e., GCS and/or IPC) (Grade 1C).
4. For urologic surgery patients who are actively bleeding, or who are at very high risk for bleeding, the guideline developers recommend the optimal use of mechanical thromboprophylaxis with GCS and/or IPC at least until the bleeding risk decreases (Grade 1A). When the high bleeding risk decreases, the guideline developers recommend that pharmacologic thromboprophylaxis be substituted for or added to the mechanical thromboprophylaxis (Grade 1C).

Laparoscopic Surgery

1. For patients undergoing entirely laparoscopic procedures who do not have additional thromboembolic risk factors, the guideline developers recommend against the routine use of thromboprophylaxis, other than early and frequent ambulation (Grade 1B).
2. For patients undergoing laparoscopic procedures, in whom additional VTE risk factors are present, the guideline developers recommend the use of thromboprophylaxis with one or more of LMWH, LDUH, fondaparinux, IPC, or GCS (all Grade 1C).

Bariatric Surgery

1. For patients undergoing inpatient bariatric surgery, the guideline developers recommend routine thromboprophylaxis with LMWH, LDUH three times daily, fondaparinux, or the combination of one of these pharmacologic methods with optimally used IPC (each Grade 1C).
2. For patients undergoing inpatient bariatric surgery, the guideline developers suggest that higher doses of LMWH or LDUH than usual for nonobese patients be used (Grade 2C).

Thoracic Surgery

1. For patients undergoing major thoracic surgery, the guideline developers recommend routine thromboprophylaxis with LMWH, LDUH, or fondaparinux (each Grade 1C).
2. For thoracic surgery patients with a high risk of bleeding, the guideline developers recommend the optimal use of mechanical thromboprophylaxis with properly fitted GCS and/or IPC (Grade 1C).

Coronary Artery Bypass (CABG) Surgery

1. For patients undergoing CABG, the guideline developers recommend the use of thromboprophylaxis with LMWH, LDUH, or optimally used bilateral GCS or IPC (Grade 1C).
2. For patients undergoing CABG, the guideline developers suggest the use of LMWH over LDUH (Grade 2B).
3. For patients undergoing CABG with a high risk of bleeding, we recommend the optimal use of mechanical thromboprophylaxis with properly fitted bilateral GCS or IPC (Grade 1C).

Orthopedic Surgery

Elective Hip Replacement

1. For patients undergoing elective total hip replacement (THR), the guideline developers recommend the routine use of one of the following anticoagulant options: (1) LMWH (at a usual high-risk dose, started 12 hours before surgery or 12 to 24 hours after surgery, or 4 to 6 hours after surgery at half the usual high-risk dose and then increasing to the usual high-risk dose the following day); (2) fondaparinux (2.5 mg started 6 to 24 hours after surgery); or (3) adjusted-dose vitamin K antagonist (VKA) started preoperatively or the evening of the surgical day (international normalized ratio [INR] target, 2.5; INR range, 2.0 to 3.0) (all Grade 1A).
2. For patients undergoing THR, the guideline developers recommended against the use of any of the following: aspirin, dextran, LDUH, GCS, or venous foot pump (VFP) as the sole method of thromboprophylaxis (all Grade 1A).
3. For patients undergoing THR who have a high risk of bleeding, the guideline developers recommend the optimal use of mechanical thromboprophylaxis with the VFP or IPC (Grade 1A). When the high bleeding risk decreases, the guideline developers recommend that pharmacologic thromboprophylaxis be substituted for or added to the mechanical thromboprophylaxis (Grade 1C).

Elective Knee Replacement

1. For patients undergoing total knee replacement (TKR), the guideline developers recommend routine thromboprophylaxis using LMWH (at the usual high-risk dose), fondaparinux, or adjusted-dose VKA INR target, 2.5; INR range, 2.0 to 3.0) (all Grade 1A).
2. For patients undergoing TKR, the optimal use of IPC is an alternative option to anticoagulant thromboprophylaxis (Grade 1B).
3. For patients undergoing TKR, the guideline developers recommend against the use of any of the following as the only method of thromboprophylaxis: aspirin (Grade 1A), LDUH (Grade 1A), or venous foot pump (VFP) (Grade 1B).
4. For patients undergoing TKR who have a high risk of bleeding, the guideline developers recommend the optimal use of mechanical thromboprophylaxis with IPC (Grade 1A) or VFP (Grade 1B). When the high bleeding risk decreases, the guideline developers recommend that pharmacologic thromboprophylaxis be substituted for or added to the mechanical thromboprophylaxis (Grade 1C).

Knee Arthroscopy

1. For patients undergoing knee arthroscopy who do not have additional thromboembolic risk factors, the guideline developers suggest that clinicians not routinely use thromboprophylaxis other than early mobilization (Grade 2B).
2. For patients undergoing arthroscopic knee surgery who have additional thromboembolic risk factors or following a complicated procedure, the guideline developers recommend thromboprophylaxis with LMWH (Grade 1B).

Hip Fracture Surgery

1. For patients undergoing hip fracture surgery (HFS), the guideline developers recommend routine thromboprophylaxis using fondaparinux (Grade 1A), LMWH (Grade 1B), adjusted-dose VKA (INR target, 2.5; INR range, 2.0 to 3.0) (Grade 1B), or LDUH (Grade 1B).
2. For patients undergoing HFS, the guideline developers recommend against the use of aspirin alone (Grade 1A).
3. For patients undergoing HFS in whom surgery is likely to be delayed, the guideline developers recommend that thromboprophylaxis with LMWH or LDUH be initiated during the time between hospital admission and surgery (Grade 1C).
4. For patients undergoing HFS who have a high risk of bleeding, the guideline developers recommend the optimal use of mechanical thromboprophylaxis (Grade 1A). When the high bleeding risk decreases, the guideline developers recommend that pharmacologic thromboprophylaxis be substituted for or added to the mechanical thromboprophylaxis (Grade 1C).

Other Thromboprophylaxis Issues in Major Orthopedic Surgery

Commencement of Thromboprophylaxis

1. For patients receiving LMWH as thromboprophylaxis in major orthopedic surgery, the guideline developers recommend starting either preoperatively or postoperatively (Grade 1A).
2. For patients receiving fondaparinux as thromboprophylaxis in major orthopedic surgery, the guideline developers recommend starting either 6 to 8 hours after surgery or the next day (Grade 1A).

Screening for Deep Vein Thrombosis (DVT) Before Hospital Discharge

For asymptomatic patients following major orthopedic surgery, the guideline developers recommend against the routine use of Doppler ultrasonography (DUS) screening before hospital discharge (Grade 1A).

Duration of Thromboprophylaxis

1. For patients undergoing THR, TKR, or HFS, the guideline developers recommend thromboprophylaxis with one of the recommended options for at least 10 days (Grade 1A).
2. For patients undergoing THR, the guideline developers recommend that thromboprophylaxis be extended beyond 10 days and up to 35 days after surgery (Grade 1A). The recommended options for extended thromboprophylaxis in THR include LMWH (Grade 1A), a VKA (Grade 1B), or fondaparinux (Grade 1C).
3. For patients undergoing TKR, the guideline developers suggest that thromboprophylaxis be extended beyond 10 days and up to 35 days after surgery (Grade 2B). The recommended options for extended thromboprophylaxis in TKR include LMWH (Grade 1C), a VKA (Grade 1C), or fondaparinux (Grade 1C).
4. For patients undergoing HFS, the guideline developers recommend that thromboprophylaxis be extended beyond 10 days and up to 35 days after surgery (Grade 1A). The recommended options for extended thromboprophylaxis in HFS include fondaparinux (Grade 1A), LMWH (Grade 1C), or a VKA (Grade 1C).

Elective Spine Surgery

1. For patients undergoing spine surgery who do not have additional thromboembolic risk factors, the guideline developers suggest that clinicians not routinely use specific thromboprophylaxis other than early and frequent ambulation (Grade 2C).
2. For patients undergoing spine surgery who have additional thromboembolic risk factors, such as advanced age, malignancy, presence of a neurologic deficit, previous VTE, or an anterior surgical approach, the guideline developers recommend that one of the following thromboprophylaxis options be used: postoperative LDUH (Grade 1B), postoperative LMWH (Grade 1B), or optimal use of perioperative IPC (Grade 1B). An alternative consideration is GCS (Grade 2B).
3. For patients undergoing spine surgery who have multiple risk factors for VTE, the guideline developers suggest that a pharmacologic method (i.e., LDUH or LMWH) be combined with the optimal use of a mechanical method (i.e., GCS and/or IPC) (Grade 2C).

Isolated Lower-Extremity Injuries Distal to the Knee

For patients with isolated lower-extremity injuries distal to the knee, the guideline developers suggest that clinicians not routinely use thromboprophylaxis (Grade 2A).

Neurosurgery

1. For patients undergoing major neurosurgery, the guideline developers recommend that thromboprophylaxis be used routinely (Grade 1A), with optimal use of IPC (Grade 1A). Acceptable alternatives to IPC are postoperative LMWH (Grade 2A) or LDUH (Grade 2B).
2. For patients undergoing major neurosurgery who have a particularly high thrombosis risk, the guideline developers suggest that a mechanical method (i.e., GCS and/or IPC) be combined with a pharmacologic method (i.e., postoperative LMWH or LDUH) (Grade 2B).

Trauma, Spinal Cord Injury, Burns

Trauma

1. For all major trauma patients, the guideline developers recommend routine thromboprophylaxis, if possible (Grade 1A).
2. For major trauma patients, in the absence of a major contraindication, the guideline developers recommend that clinicians use LMWH thromboprophylaxis starting as soon as it is considered safe to do so (Grade 1A). An acceptable alternative is the combination of LMWH and the optimal use of a mechanical method of thromboprophylaxis (Grade 1B).
3. For major trauma patients, if LMWH thromboprophylaxis is contraindicated due to active bleeding or high risk for clinically important bleeding, the guideline developers recommend that mechanical thromboprophylaxis with IPC, or possibly with GCS alone be used (Grade 1B). When the high bleeding risk decreases, the guideline developers recommend that pharmacologic thromboprophylaxis be substituted for or added to the mechanical thromboprophylaxis (Grade 1C).
4. In trauma patients, the guideline developers  recommend against routine DUS screening for asymptomatic DVT (Grade 1B). The guideline developers do recommend DUS screening in patients who are at high risk for VTE (e.g., in the presence of a spinal cord injury [SCI], lower-extremity or pelvic fracture, or major head injury) and who have received suboptimal thromboprophylaxis or no thromboprophylaxis (Grade 1C).
5. For trauma patients, the guideline developers recommend against the use of an inferior vena cava filter as thromboprophylaxis (Grade 1C).
6. For major trauma patients, the guideline developers recommend the continuation of thromboprophylaxis until hospital discharge (Grade 1C). For trauma patients with impaired mobility who undergo inpatient rehabilitation, the guideline developers suggest continuing thromboprophylaxis with LMWH or a VKA (target INR, 2.5; range, 2.0 to 3.0) (Grade 2C).

Acute Spinal Cord injury (SCI)

1. For all patients with acute SCI, the guideline developers recommend that routine thromboprophylaxis be provided (Grade 1A).
2. For patients with acute SCI, the guideline developers recommend thromboprophylaxis with LMWH, commenced once primary hemostasis is evident (Grade 1B). Alternatives include the combined use of IPC and either LDUH (Grade 1B) or LWMH (Grade 1C).
3. For patients with acute SCI, the guideline developers recommend the optimal use of IPC and/or GCS if anticoagulant thromboprophylaxis is contraindicated because of high bleeding risk early after injury (Grade 1A). When the high bleeding risk decreases, the guideline developers recommend that pharmacologic thromboprophylaxis be substituted for or added to the mechanical thromboprophylaxis (Grade 1C).
4. For patients with an incomplete SCI associated with evidence of a spinal hematoma on computed tomography (CT) or magnetic resonance imaging (MRI), the guideline developers recommend the use of mechanical thromboprophylaxis instead of anticoagulant thromboprophylaxis at least for the first few days after injury (Grade 1C).
5. Following acute SCI, the guideline developers recommend against the use of LDUH alone (Grade 1A).
6. For patients with SCI, the guideline developers recommend against the use of an inferior vena cava filter as thromboprophylaxis (Grade 1C).
7. For patients undergoing rehabilitation following acute SCI, the guideline developers recommend the continuation of LMWH thromboprophylaxis or conversion to an oral VKA (INR target, 2.5; range, 2.0 to 3.0) (Grade 1C).

Burns

1. For burn patients who have additional risk factors for VTE, including one or more of the following: advanced age, morbid obesity, extensive or lower-extremity burns, concomitant lower-extremity trauma, use of a femoral venous catheter, and/or prolonged immobility, the guideline developers recommend routine thromboprophylaxis if possible (Grade 1A).
2. For burn patients who have additional risk factors for VTE, if there are no contraindications, the guideline developers recommend the use of either LMWH or LDUH, starting as soon as it is considered safe to do so (Grade 1C).
3. For burn patients who have a high bleeding risk, the guideline developers recommend mechanical thromboprophylaxis with GCS and/or IPC until the bleeding risk decreases (Grade 1A).

Medical Conditions

1. For acutely ill medical patients admitted to hospital with congestive heart failure or severe respiratory disease, or who are confined to bed and have one or more additional risk factors, including active cancer, previous VTE, sepsis, acute neurologic disease, or inflammatory bowel disease, the guideline developers recommend thromboprophylaxis with LMWH (Grade 1A), LDUH (Grade 1A), or fondaparinux (Grade 1A).
2. For medical patients with risk factors for VTE, and for whom there is a contraindication to anticoagulant thromboprophylaxis, the guideline developers recommend the optimal use of mechanical thromboprophylaxis with GCS or IPC (Grade 1A).

Cancer Patients

1. For cancer patients undergoing surgical procedures, the guideline developers recommend routine thromboprophylaxis that is appropriate for the type of surgery (Grade 1A). Refer to the recommendations in the relevant surgical subsections.
2. For cancer patients who are bedridden with an acute medical illness, the guideline developers recommend routine thromboprophylaxis as for other high-risk medical patients (Grade 1A). Refer to the recommendations in the "Medical Conditions" section above.
3. For cancer patients with indwelling central venous catheters, the guideline developers recommend that clinicians not use either prophylactic doses of LMWH (Grade 1B) or mini-dose warfarin (Grade 1B) to try to prevent catheter-related thrombosis.
4. For cancer patients receiving chemotherapy or hormonal therapy, the guideline developers recommend against the routine use of thromboprophylaxis for the primary prevention of VTE (Grade 1C).
5. For cancer patients, the guideline developers recommend against the routine use of primary thromboprophylaxis to try to improve survival (Grade 1B).

Critical Care

1. For patients admitted to a critical care unit, the guideline developers recommend routine assessment for VTE risk and routine thromboprophylaxis in most (Grade 1A).
2. For critical care patients who are at moderate risk for VTE (e.g., medically ill or postoperative general surgery patients), the guideline developers recommend using LMWH or LDUH thromboprophylaxis (Grade 1A).
3. For critical care patients who are at higher risk (e.g., following major trauma or orthopedic surgery), the guideline developers recommend LMWH thromboprophylaxis (Grade 1A).
4. For critical care patients who are at high risk for bleeding, the guideline developers recommend the optimal use of mechanical thromboprophylaxis with GCS and/or IPC at least until the bleeding risk decreases (Grade 1A). When the high bleeding risk decreases, the guideline developers recommend that pharmacologic thromboprophylaxis be substituted for or added to the mechanical thromboprophylaxis (Grade 1C).

Long Distance Travel

1. For travelers who are taking flights > 8 hours, the guideline developers recommend the following general measures: avoidance of constrictive clothing around the lower extremities or waist, maintenance of adequate hydration, and frequent calf muscle contraction (Grade 1C).
2. For long-distance travelers with additional risk factors for VTE, the guideline developers recommend the general measures listed above. If active thromboprophylaxis is considered because of a perceived high risk of VTE, the guideline developers suggest the use of properly fitted, below-knee GCS, providing 15 to 30 mm Hg of pressure at the ankle (Grade 2C), or a single prophylactic dose of LMWH, injected prior to departure (Grade 2C).
3. For long-distance travelers, the guideline developers recommend against the use of aspirin for VTE prevention (Grade 1B).

Definitions:

*The guideline developers use the wording recommend for strong (Grade 1) recommendations and suggest for weak (Grade 2) recommendations.

None provided

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

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

2001 Jan (revised 2008 Jun)

American College of Chest Physicians - Medical Specialty Society

American College of Chest Physicians

American College of Chest Physicians (ACCP) Expert Panel on Antithrombotic and Thrombolytic Therapy

Primary Authors: William H. Geerts, MD, FCCP; David Bergqvist, MD, PhD; Graham F. Pineo, MD; John A. Heit, MD; Charles M. Samama, MD, PhD, FCCP; Michael R. Lassen, MD; Clifford W. Colwell, MD

Committee Co-Chairs: Jack Hirsh, MD, FCCP (Chair); Gordon H. Guyatt, MD, FCCP; Gregory W. Albers, MD; Robert A. Harrington, MD, FCCP; Holger J. Schünemann, MD, PhD, FCCP

Participants: Giancarlo Agnelli, MD; Pierre Amarenco, MD; Jack E. Ansell, MD; Collin Baigent; Shannon M. Bates, MD; Kenneth A. Bauer, MD; Richard C. Becker, MD; Peter B. Berger, MD; David Bergqvist, MD, PhD; Rebecca J. Beyth, MD; Christopher P. Cannon, MD; Elizabeth A. Chalmers, MB, ChB, MD; Anthony K.C. Chan, MBBS; Clifford W. Colwell, Jr., MD; Anthony J. Comerota, MD; Deborah Cook, MD; Mark A. Crowther, MD; James E. Dalen, MD; Gabrielle deVeber, MD, MHSc; Maria Benedetta Donati, MD, PhD; James D. Douketis, MD; Andrew Dunn, MD; J. Donald Easton, MD; Michael Ezekowitz, MD; Margaret Fang; William H. Geerts, MD, FCCP; Alan S. Go, MD; Samuel Z. Goldhaber, MD, FCCP; Shaun D. Goodman, MD; Michael Gould, MD, FCCP; Ian A. Greer, MD; Andreas Greinacher, MD; David Gutterman, MD, FCCP, HSP; Jonathan L. Halperin, MD; John A. Heit, MD; Elaine M. Hylek, MD; Alan Jacobson, MD; Roman Jaeschke, MD, PhD; Amir K. Jaffer, MD; Susan Kahn; Clive Kearon, MBBCh, PhD; Fenella Kirkham, MBBC; Andreas Koster, MD, PhD; Michael R. Lassen, MD; Mark N. Levine, MD, MSc; Sandra Zelman Lewis, PhD; A. Michael Lincoff, MD; Gregory YH Lip, MD; Christopher Madias, MD; Warren J. Manning, MD; Daniel B. Mark, MD; M. Patricia Massicotte, MD, MSc; David Matchar, MD; Thomas W. Meade, DM, FCCP; Venu Menon, MD; Tracy Minichiello, MD; Paul Monagle, MBBS, MSc, MD, FCCP; Christopher M. O'Connor, MD; Patrick O'Gara, MD; E. Magnus Ohman, MD; Ingrid Pabinger, MD; Gualtiero Palareti, MD; Carlo Patrono, MD; Stephen G. Pauker, MD; Graham F. Pineo, MD; Jeffrey J. Popma, MD; Gary Raskob, PhD; Gerald Roth, MD; Ralph L. Sacco, MD; Deeb N. Salem, MD, FCCP; Charles-Marc Samama, MD, FCCP; Meyer Michel Samama, MD; Sam Schulman, MD, PhD; Daniel Singer, MD; Michael Sobel, MD; Shoshanna Sofaer, DrPH; Alex C. Spyropoulos, MD FCCP; Ph. Gabriel Steg, MD; Philip Teal, MD; Raymond Verhaeghe, MD; David A. Vorchheimer, MD; Theodore E. Warkentin, MD; Jeffrey Weitz, MD

Dr. Geerts discloses that he has received grant monies from the Canadian Institutes for Health Research, Sanofi-Aventis, and Pfizer. He has received consultant fees from Bayer, Eisai, GlaxoSmithKline, Lilly, Merck, Pfizer, Roche, and Sanofi-Aventis, along with speakers honoraria from Bayer, Calea, Oryx, Pfizer, and Sanofi-Aventis.

Dr. Bergqvist discloses that he has received grant monies from the Swedish Research Council and the Heart and Lung Foundation. He has also served on advisory committees for AstraZeneca, Pfizer, Boehringer Ingelheim, and Sanofi-Aventis.

Dr. Colwell discloses that he received grant monies from the Aircast Foundation and the National Institutes of Health. He received consultant fees from AstraZeneca, Sanofi-Aventis, and Eisai, and has served on advisory committees for Wyeth-Ayerst. Dr. Colwell also received research funding from Boehringer Ingelheim, Bayer Healthcare, and Stryker.

Dr. Heit reveals no real or potential conflicts of interest or commitment.

Dr. Lassen discloses that he has received consultant fees from AstraZeneca, Bristol-Myers Squibb, Pfizer, Sanofi-Aventis, Astellas, and Bayer. He is also on the advisory committees of AstraZeneca, Bristol-Myers Squibb, Pfizer, Sanofi-Aventis, Astellas, Bayer, GlaxoSmithKline, Boehringer Ingelheim, and Besst-test.

Dr. Samama discloses that he has received grant monies from Novo Nordisk, Sanofi, and Pfizer. He has received consultant fees from Pfizer. Dr. Samama has served on the speakers bureau of Boehringer Ingelheim and Sanofi, and has assisted advisory committees of BMS, AstraZeneca, Bayer, GlaxoSmithKline, and Mitsubishi.

Dr. Pineo discloses that he has received consultant fees from Sanofi-Aventis, BMS, Daiichi Sankyo, and Telecvis. He is involved with the speakers bureaus of Sanofi-Aventis, Leo, and Pfizer. Dr. Pineo assists the advisory committees of Sanofi-Aventis, Pfizer, Telecvis, Leo, and Bayer.

American College of Clinical Pharmacy - Medical Specialty Society
American Society of Health-System Pharmacists - Professional Association

This is the current release of the guideline.

This guideline updates a previous version: Geerts WH, Pineo GF, Heit JA, Bergqvist D, Lassen MR, Colwell CW, Ray JG. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004 Sep;126(3 Suppl):338S-400S.

None available

This summary was completed by ECRI on July 12, 2001. The information was verified by the guideline developer on September 27, 2001. This summary was updated by ECRI on December 28, 2004. The updated information was verified by the guideline developer on January 12, 2005. This summary was updated by ECRI Institute on June 22, 2007 following the U.S. Food and Drug Administration (FDA) advisory on heparin sodium injection. This summary was updated by ECRI Institute on March 14, 2008 following the updated FDA advisory on heparin sodium injection. This summary was updated by ECRI Institute on November 24, 2008. The updated information was verified by the guideline developer on January 7, 2009.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.