What are the optimal strategies for the prevention of venous thromboembolism in surgical hospitalized patients?
The 2019 ASH guidelines provide conditional recommendations for VTE prophylaxis tailored to specific surgical patient populations, favoring mechanical or pharmacological prophylaxis in high-risk groups while advising against pharmacological prophylaxis in certain bleeding-prone surgeries.
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.
Anderson et al. (Tue,) studied this question.