Documentos de Académico
Documentos de Profesional
Documentos de Cultura
Agus Harsoyo, MD Consultant Cardiovascular Intervention Consultant Clinical Cardiac Electrophysiology and Device Implantable
Unit Clinical Cardiac Electrophysiology and device Implantable, Cardiovascular Intervention , UPNV Jakarta Faculty of Medicine, Department of Cardiology, Gatot Soebroto Army Center Hospital, Jakarta, Indonesia
2013
RISK STRATIFICATION
Low Risk: Minor surgery in patients <40 years with no additional risk factors Moderate Risk: Minor surgery in patients with additional risk factors . Surgery in patients aged 40-60 years with no additional risk factors . High Risk: Surgery in patients >60 years .Surgery in patients aged 40-60 years with additional risk factors (prior venous thromboembolism, cancer, hypercoagulable state) Highest Risk: Surgery in patients with multiple risk factors (age >40 years, cancer, prior venous thromboembolism)
For patients undergoing major thoracic surgery, we recommend routine thromboprophylaxis with LMWH, LDUH, or fondaparinux (each Grade 1C). For thoracic surgery patients with a high risk of bleeding, we recommend the optimal use of mechanical thromboprophylaxis with properly fitted GCS and/or IPC (Grade 1C).
We recommend against the use of aspirin alone as thromboprophylaxis against VTE for any patient group (Grade 1A)
VENOUS THROMBOEMBOLIC DISEASE : EVIDENCE BASED PRACTICE GUIDELINES In patients with acute DVT, we recommend initial treatment with LMWH SC once or twice daily, as an outpatient if possible (Grade 1C), or as an inpatient if necessary (Grade 1A), rather than treatment with IV UFH. In patients with acute DVT treated with LMWH, we recommend against routine monitoring with antifactor Xa level measurements (Grade 1A). In patients with acute DVT and severe renal failure, we suggest UFH over LMWH (Grade 2C).
VENOUS THROMBOEMBOLIC DISEASE : EVIDENCE BASED PRACTICE GUIDELINES For patients with DVT and cancer, we recommend LMWH for the first 3 to 6 months of long-term anticoagulant therapy (Grade 1A). For these patients, we recommend subsequent anticoagulant therapy with VKA or LMWH indefinitely or until the cancer is resolved (also, see Section 2.4) [Grade 1C].
VENOUS THROMBOEMBOLIC DISEASE : EVIDENCE BASED PRACTICE GUIDELINES For patients with acute UEDVT, we recommend treatment with a VKA for 3 months (Grade 1C). For most patients with UEDVT in association with an indwelling central venous catheter, we suggest that the catheter not be removed if it is functional and there is an ongoing need for the catheter (Grade 2C). For patients who have UEDVT in association with an indwelling central venous catheter that is removed, we do not recommend that the duration of longterm anticoagulant treatment be shortened to < 3 months (Grade 2C).