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

David R. Anderson; Gian Paolo Morgano; Carole Bennett; Francesco Dentali; Charles W. Francis; David A. Garcia; Susan R. Kahn; Maryam Rahman; Anita Rajasekhar; Frederick B. Rogers; Maureen A. Smythe; Kari A.O. Tikkinen; Adolph J. Yates; Tejan Baldeh; Sara Balduzzi; Jan L. Brozek; Itziar Etxeandia-Ikobaltzeta; Herman Johal; Ignacio Neumann; Wojtek Wiercioch; Juan José Yepes-Nunez; Holger J. Schünemann; Philipp Dahm

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, Gian Paolo Morgano, Carole Bennett, Francesco Dentali, Charles W. Francis, David A. Garcia, Susan R. Kahn, Maryam Rahman, Anita Rajasekhar, Frederick B. Rogers, Maureen A. Smythe, Kari A.O. Tikkinen, Adolph J. Yates, Tejan Baldeh, Sara Balduzzi, Jan L. Brozek, Itziar Etxeandia-Ikobaltzeta, Herman Johal, Ignacio Neumann, Wojtek WierciochJuan José Yepes-Nunez, Holger J. Schünemann, Philipp Dahm

Medicine

Research output: Contribution to journal › Article › peer-review

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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 5 8), orthopedic surgery (n 5 7), major general surgery (n 5 3), major neurosurgical procedures (n 5 2), urological surgery (n 5 4), cardiac surgery and major vascular surgery (n 5 2), major trauma (n 5 2), and major gynecological surgery (n 5 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.

Original language	English
Pages (from-to)	3898-3944
Number of pages	47
Journal	Blood advances
Volume	3
Issue number	23
DOIs	https://doi.org/10.1182/bloodadvances.2019000975
Publication status	Published - 2019

Bibliographical note

Funding Information:
The authors thank Joyce Kirkman and Tracy Minichiello for participation on the panel during the initial stages of the guideline-development process, including to prioritize questions and health outcomes. The authors acknowledge Angela Barbara, Housne Begum, Samantha Craigie, Andrea Darzi, Farid Foroutan, Nora Ibargoyen Roteta, Rana Qadeer, Yasir Rehman, Mansoor Radwi, Matthew Ventresca, and Robby Nieuwlaat for supporting the systematic reviews and Wojtek Wiercioch, Robby Nieuwlaat, and Holger Schünemann for coordination of the systematic review team. Holger Schünemann prepared a template of these guidelines for all panels that was critically reviewed by Adam Cuker, Rob Kunkle, the ASH Guideline Oversight Subcommittee, the Methods Group supporting the guidelines, and Blood Advances editors.

Funding Information:
The work of this panel was coordinated with 9 other guideline panels (addressing other aspects of VTE management) by ASH and the McMaster GRADE Centre (funded by ASH under a paid agreement). Project oversight was provided initially by a coordination panel, which reported to the ASH Committee on Quality, and then by the coordination panel chair (Adam Cuker) and vice chair (H.J.S.). ASH vetted and appointed individuals to the guideline panel. The McMaster GRADE Centre vetted and retained researchers to conduct systematic reviews of evidence and coordinate the guideline-development process, including the use of the GRADE approach. The membership of the panels and the GRADE Centre team is described in Supplement 1.

Publisher Copyright:
© 2019 American Society of Hematology. All rights reserved.

ASJC Scopus Subject Areas

Hematology

PubMed: MeSH publication types

Historical Article
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10.1182/bloodadvances.2019000975

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Anderson, D. R., Morgano, G. P., Bennett, C., Dentali, F., Francis, C. W., Garcia, D. A., Kahn, S. R., Rahman, M., Rajasekhar, A., Rogers, F. B., Smythe, M. A., Tikkinen, K. A. O., Yates, A. J., Baldeh, T., Balduzzi, S., Brozek, J. L., Etxeandia-Ikobaltzeta, I., Johal, H., Neumann, I., ... Dahm, P. (2019). American Society of Hematology 2019 guidelines for management of venous thromboembolism: Prevention of venous thromboembolism in surgical hospitalized patients. Blood advances, 3(23), 3898-3944. https://doi.org/10.1182/bloodadvances.2019000975

Anderson, DR, Morgano, GP, Bennett, C, Dentali, F, Francis, CW, Garcia, DA, Kahn, SR, Rahman, M, Rajasekhar, A, Rogers, FB, Smythe, MA, Tikkinen, KAO, Yates, AJ, Baldeh, T, Balduzzi, S, Brozek, JL, Etxeandia-Ikobaltzeta, I, Johal, H, Neumann, I, Wiercioch, W, Yepes-Nunez, JJ, Schünemann, HJ & Dahm, P 2019, 'American Society of Hematology 2019 guidelines for management of venous thromboembolism: Prevention of venous thromboembolism in surgical hospitalized patients', Blood advances, vol. 3, no. 23, pp. 3898-3944. https://doi.org/10.1182/bloodadvances.2019000975

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title = "American Society of Hematology 2019 guidelines for management of venous thromboembolism: Prevention of venous thromboembolism in surgical hospitalized patients",

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 5 8), orthopedic surgery (n 5 7), major general surgery (n 5 3), major neurosurgical procedures (n 5 2), urological surgery (n 5 4), cardiac surgery and major vascular surgery (n 5 2), major trauma (n 5 2), and major gynecological surgery (n 5 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.",

author = "Anderson, {David R.} and Morgano, {Gian Paolo} and Carole Bennett and Francesco Dentali and Francis, {Charles W.} and Garcia, {David A.} and Kahn, {Susan R.} and Maryam Rahman and Anita Rajasekhar and Rogers, {Frederick B.} and Smythe, {Maureen A.} and Tikkinen, {Kari A.O.} and Yates, {Adolph J.} and Tejan Baldeh and Sara Balduzzi and Brozek, {Jan L.} and Itziar Etxeandia-Ikobaltzeta and Herman Johal and Ignacio Neumann and Wojtek Wiercioch and Yepes-Nunez, {Juan Jos{\'e}} and Sch{\"u}nemann, {Holger J.} and Philipp Dahm",

note = "Funding Information: The authors thank Joyce Kirkman and Tracy Minichiello for participation on the panel during the initial stages of the guideline-development process, including to prioritize questions and health outcomes. The authors acknowledge Angela Barbara, Housne Begum, Samantha Craigie, Andrea Darzi, Farid Foroutan, Nora Ibargoyen Roteta, Rana Qadeer, Yasir Rehman, Mansoor Radwi, Matthew Ventresca, and Robby Nieuwlaat for supporting the systematic reviews and Wojtek Wiercioch, Robby Nieuwlaat, and Holger Sch{\"u}nemann for coordination of the systematic review team. Holger Sch{\"u}nemann prepared a template of these guidelines for all panels that was critically reviewed by Adam Cuker, Rob Kunkle, the ASH Guideline Oversight Subcommittee, the Methods Group supporting the guidelines, and Blood Advances editors. Funding Information: The work of this panel was coordinated with 9 other guideline panels (addressing other aspects of VTE management) by ASH and the McMaster GRADE Centre (funded by ASH under a paid agreement). Project oversight was provided initially by a coordination panel, which reported to the ASH Committee on Quality, and then by the coordination panel chair (Adam Cuker) and vice chair (H.J.S.). ASH vetted and appointed individuals to the guideline panel. The McMaster GRADE Centre vetted and retained researchers to conduct systematic reviews of evidence and coordinate the guideline-development process, including the use of the GRADE approach. The membership of the panels and the GRADE Centre team is described in Supplement 1. Publisher Copyright: {\textcopyright} 2019 American Society of Hematology. All rights reserved.",

year = "2019",

doi = "10.1182/bloodadvances.2019000975",

language = "English",

volume = "3",

pages = "3898--3944",

journal = "Blood advances",

issn = "2473-9529",

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T1 - American Society of Hematology 2019 guidelines for management of venous thromboembolism

T2 - Prevention of venous thromboembolism in surgical hospitalized patients

AU - Anderson, David R.

AU - Morgano, Gian Paolo

AU - Bennett, Carole

AU - Dentali, Francesco

AU - Francis, Charles W.

AU - Garcia, David A.

AU - Kahn, Susan R.

AU - Rahman, Maryam

AU - Rajasekhar, Anita

AU - Rogers, Frederick B.

AU - Smythe, Maureen A.

AU - Tikkinen, Kari A.O.

AU - Yates, Adolph J.

AU - Baldeh, Tejan

AU - Balduzzi, Sara

AU - Brozek, Jan L.

AU - Etxeandia-Ikobaltzeta, Itziar

AU - Johal, Herman

AU - Neumann, Ignacio

AU - Wiercioch, Wojtek

AU - Yepes-Nunez, Juan José

AU - Schünemann, Holger J.

AU - Dahm, Philipp

N1 - Funding Information: The authors thank Joyce Kirkman and Tracy Minichiello for participation on the panel during the initial stages of the guideline-development process, including to prioritize questions and health outcomes. The authors acknowledge Angela Barbara, Housne Begum, Samantha Craigie, Andrea Darzi, Farid Foroutan, Nora Ibargoyen Roteta, Rana Qadeer, Yasir Rehman, Mansoor Radwi, Matthew Ventresca, and Robby Nieuwlaat for supporting the systematic reviews and Wojtek Wiercioch, Robby Nieuwlaat, and Holger Schünemann for coordination of the systematic review team. Holger Schünemann prepared a template of these guidelines for all panels that was critically reviewed by Adam Cuker, Rob Kunkle, the ASH Guideline Oversight Subcommittee, the Methods Group supporting the guidelines, and Blood Advances editors. Funding Information: The work of this panel was coordinated with 9 other guideline panels (addressing other aspects of VTE management) by ASH and the McMaster GRADE Centre (funded by ASH under a paid agreement). Project oversight was provided initially by a coordination panel, which reported to the ASH Committee on Quality, and then by the coordination panel chair (Adam Cuker) and vice chair (H.J.S.). ASH vetted and appointed individuals to the guideline panel. The McMaster GRADE Centre vetted and retained researchers to conduct systematic reviews of evidence and coordinate the guideline-development process, including the use of the GRADE approach. The membership of the panels and the GRADE Centre team is described in Supplement 1. Publisher Copyright: © 2019 American Society of Hematology. All rights reserved.

PY - 2019

Y1 - 2019

N2 - 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 5 8), orthopedic surgery (n 5 7), major general surgery (n 5 3), major neurosurgical procedures (n 5 2), urological surgery (n 5 4), cardiac surgery and major vascular surgery (n 5 2), major trauma (n 5 2), and major gynecological surgery (n 5 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.

AB - 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 5 8), orthopedic surgery (n 5 7), major general surgery (n 5 3), major neurosurgical procedures (n 5 2), urological surgery (n 5 4), cardiac surgery and major vascular surgery (n 5 2), major trauma (n 5 2), and major gynecological surgery (n 5 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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American Society of Hematology 2019 guidelines for management of venous thromboembolism: Prevention of venous thromboembolism in surgical hospitalized patients

Abstract

Bibliographical note

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PubMed: MeSH publication types

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