Six studies38,280,353-356  were conducted on patients undergoing urological surgery. We identified 3 studies386-388  in these reviews that fulfilled our inclusion criteria and measured outcomes relevant to this context. The panel rated the magnitude of the desirable and undesirable effects of using LMWH over UFH as trivial. For patients at moderate risk for VTE who are not at high risk for major bleeding complications, it was suggested to use LMWH, low-dose UFH, or mechanical prophylaxis with intermittent pneumatic compression over no prophylaxis. We were unable to assess the effect on reoperations. There would probably be no impact on health equity; combined pharmacological and mechanical prophylaxis would probably be acceptable to stakeholders and probably feasible to implement. Rates of major reoperation may be similar (RR, 2.96; 95% CI, 0.73-12.05; low certainty in the evidence of effects) between the 2 interventions, corresponding to 4 more (1 fewer to 21 more) per 1000 patients. If a DOAC is not used, the panel suggests using LMWH rather than warfarin (conditional recommendation based on very low certainty in the evidence of effects ⊕◯◯◯) and recommends LMWH rather than unfractionated heparin (UFH) (strong recommendation based on moderate certainty in the evidence of effects ⊕⊕⊕◯). Based on these findings, the panel judged that the balance of effects did not favor any particular DOAC over another. Anticoagulation may consist of a parenteral anticoagulant overlapped by warfarin or followed by a direct oral anticoagulant (DOAC) (dabigatran or edoxaban), or of a DOAC (apixaban or rivaroxaban) without initial parenteral therapy. The very low certainty in the evidence justifies conditional recommendations for both scenarios. Depending on the baseline risk, this benefit likely corresponds to 5 fewer (3-6 fewer) per 1000 patients with a baseline risk of 0.8% to up to 7 fewer (4-8 fewer) per 1000 patients based on a baseline risk of 1.2% from observational data.73  We are very uncertain whether the risks of symptomatic proximal DVTs (RR, 0.14; 95% CI, 0.01-2.63; very low certainty in the evidence of effects) and symptomatic distal DVTs (RR, 1.99; 95% CI, 0.35-11.33; very low certainty in the evidence of effects) differ between the 2 groups. In Part A of the forms, individuals disclosed material interests for 2 years prior to appointment. We are uncertain whether pharmacological prophylaxis reduces the rates of proximal DVTs (RR, 0.38; 95% CI, 0.14-1.00; very low certainty in the evidence of effects), corresponding to reduction of 4 fewer (0-6 fewer) symptomatic proximal DVTs per 1000 lower-risk patients and 17 fewer (0-23 fewer) per 1000 higher-risk patients based on baseline risks from observation data of 0.7% and 2.7%, respectively.396,397  We are uncertain about the effect of pharmacological prophylaxis on distal DVTs (RR, 0.52; 95% CI, 0.31-0.87; low certainty in the evidence of effects), corresponding to no reduction per 1000 patients treated based on a lower baseline risk of 0.1%. The guideline panel judged that the net benefit favors no pharmacological prophylaxis for patients undergoing radical prostatectomy, based on very low certainty in the evidence of effects. DOAC prophylaxis vs prophylaxis with another DOAC, 12. Question: Should pharmacological prophylaxis vs no pharmacological prophylaxis be used for patients undergoing laparoscopic cholecystectomy? The exception was that the need for a blood transfusion itself was not considered major bleeding unless other criteria for major bleeding were met. There may be no difference in mortality between pharmacological prophylaxis combined with mechanical prophylaxis and pharmacological prophylaxis alone (RR, 0.29; 95% CI, 0.06-1.38; low certainty in the evidence of effects); this corresponds to 5 fewer (7 fewer to 3 more) deaths per 1000 patients. In most circumstances, these innovations would be expected to reduce the overall risk of postoperative VTEs. These guidelines include the 2012 ACCP guideline, the 2014 Korean Society of Thrombosis and Hemostasis Evidence-Based Clinical Practice Guidelines, the 2018 NICE guideline, the 2010 SIGN guideline, the 2017 European Society of Anesthesiology guideline, and the 2016 Neurocritical Care Society guidelines.398,400,401,404,409,410  The recommendations provided by these current ASH guidelines are similar to the 2010 SIGN guidelines, the 2019 Congress of Neurological Surgeons Guidelines for Spine Trauma, and the 2012 ACCP guidelines. This document may also serve as the basis for adaptation by local, regional, or national guideline panels. We are very uncertain of its effect on symptomatic proximal DVTs (RR, 0.38; 95% CI, 0.14-1.00; very low certainty in the evidence of effects), which would correspond to 1 fewer (0-1 fewer) symptomatic event in 1000 lower-risk patients or 3 fewer (0-5 fewer) events per 1000 higher-risk patients. Examples of such innovations include use of minimally invasive surgical procedures, early and increased postoperative patient mobilization, and use of regional anesthesia; however, it is uncertain whether such changes in surgical practice impact the relative effectiveness of various thromboembolic interventions. Pharmacological prophylaxis vs mechanical prophylaxis, 2. The panel acknowledges that the overall certainty in the evidence was low, in particular as a result of indirectness, with most of the trial data included in the analysis involving patients undergoing major surgical procedures. In a moderate-risk population with a baseline risk of 2.5%,267  this corresponds to 12 fewer (8-16 fewer) per 1000 patients. The panel recognized there was a paucity of high-quality evidence addressing this particular question, and this recommendation was made in the face of very uncertain evidence. Guidelines addressing the prophylactic placement of IVC filters include the 2012 ACCP guidelines,398  the 2011 AAOS guideline for orthopedic patients,402  the 2013 European Venous Forum,403  the 2013 guidelines by the Neurocritical Care Society,404  the 2013 British Committee for Standards in Hematology guidelines, and the “appropriateness criteria” by the American College of Radiology.406  The recommendation made by these ASH guidelines corresponds with many of these existing recommendations that are mostly critical of prophylactic IVC filter placement for patients requiring major surgery or who have experienced trauma. The guideline panel determined that there was very low certainty evidence for a net health benefit/harm for mechanical prophylaxis. A pilot study, Comparison of the use of a foot pump with the use of low-molecular-weight heparin for the prevention of deep-vein thrombosis after total hip replacement. When DVT is confirmed, anticoagulation is indicated to control symptoms, prevent progression and reduce the risk of post‐thrombotic syndrome and pulmonary embolism. contributed evidence summaries to the guidelines; D.R.A. Equity, acceptability, and feasibility were not considered major factors. These ASH guidelines stand out by their scope, which includes general issues relevant to any surgical procedure and those related to surgical subspecialties. Thirty studies reported the effect of LMWH vs UFH on risk of mortality.305,307,308,310-312,314,317-319,321,322,325-327,329-339,341,342,346,347  Thirty-one studies reported the effect of LMWH vs UFH on development of symptomatic PEs,295,305-306,310-312,314-319,321,322,324,326-335,337,339,344-346  5 studies reported the effect on symptomatic proximal DVTs,306,316,326,334,336  and 7 reported the effect on symptomatic distal DVTs.306,316,326,329,334,336,341  Thirty-four studies reported the effect of LMWH vs UFH on risk of major bleeding,295,305-307,311,313,315-319,321-339,341,344-346  and 16 studies reported the effect on risk of reoperation.305,307,309,317,319,322,323,326,329,330,333-337,341. For determining baseline risk of VTEs and major bleeding, we used data, where available, from contemporary large cohort studies that were deemed representative of contemporary patients. Pharmacological prophylaxis probably reduces mortality slightly following major gynecological surgery (RR, 0.75; 95% CI, 0.61-0.93; low certainty in the evidence of effects). The EtD framework is available online at https://guidelines.gradepro.org/profile/61E7ADC1-4C91-8D58-9E3A-56BFEE3EAC20. They further judged that the balance between desirable and undesirable effects probably favors extended-duration vs standard-duration prophylaxis. The use of these guidelines is also facilitated by the links to the EtD frameworks and interactive summary-of-findings tables in each section. The panel based its recommendation on the judgment that the desirable benefits of pharmacological prophylaxis outweighed the likely small increased risk of major bleeding following major gynecological procedures. When the risk for VTE is very low, it was recommended not to use pharmacological or mechanical prophylaxis. We identified 7 systematic reviews addressing this question.23-26,28,29,31  We identified 19 studies in these reviews that fulfilled our inclusion criteria and measured outcomes relevant to this context.36,60,62,68,70,104-117  Our systematic search of RCTs did not identify any additional study that fulfilled the inclusion criteria. Determinants and time course of the postthrombotic syndrome after acute deep venous thrombosis. Acute DVT may be treated in an outpatient setting with LMWH. Duplex ultrasonography is an imaging test that uses sound waves to look at the flow of blood in the veins. We identified 4 studies in this review that fulfilled our inclusion criteria and measured outcomes relevant to this context.348,365-367  Our update of the systematic review identified 1 additional study that fulfilled the inclusion criteria.368  All studies included patients undergoing neurosurgical procedures. These American Society of Hematology (ASH) guidelines are based on updated and original systematic reviews of evidence conducted by researchers and developed under the direction of the McMaster University GRADE Centre with international collaborators. Likewise, use of LMWH prophylaxis vs UFH prophylaxis appears to result in little or no difference in symptomatic PEs (RR, 0.91; 95% CI, 0.63-1.3; low certainty in the evidence of effects). The panel used the GRADEpro Guideline Development Tool (www.gradepro.org) and SurveyMonkey (www.surveymonkey.com) to brainstorm and then prioritize the questions described in Table 1. Question: Should early vs delayed antithrombotic prophylaxis be used for patients undergoing major surgery? In February 2016, an update to the ninth edition of the antithrombotic guideline from the American College of Chest Physician (ACCP) was published and included updated recommendations on 12 topics in addition to three new topics. Morbidity and mortality after surgery for lower urinary tract symptoms: a study of 95 577 cases from a nationwide German health insurance database, Urology Section of the Bavarian Working Group for Quality Assurance, Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients, Surgical management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA Guideline, Comparison of low molecular weight heparin vs. unfractionated heparin in gynecological surgery. 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.). Pharmacological prophylaxis may not reduce overall mortality compared with no pharmacological prophylaxis (RR, 0.75; 95% CI, 0.61 to 0.93; low certainty in the evidence of effects). After publication of these guidelines, ASH will maintain them through surveillance for new evidence, ongoing review by experts, and regular revisions. Further research on the incremental impact of postoperative UFH and LMWH exposure on the development of HIT in this patient population is also warranted. The panel noted that such studies are underway. Conflicts of interest of all participants were managed according to ASH policies based on recommendations of the Institute of Medicine17  and the Guidelines International Network.4  At the time of appointment, a majority of the guideline panel, including the chair and the vice chair, had no conflicts of interest as defined and judged by ASH (ie, no current material interest in any commercial entity with a product that could be affected by the guidelines). A prospective double-blind multicentre trial on prevention of postoperative thrombosis, A randomized double-blind study between a low molecular weight heparin Kabi 2165 and standard heparin in the prevention of deep vein thrombosis in general surgery. LMWH prophylaxis vs warfarin prophylaxis, 14. For mechanical interventions, such as graduated or mechanical compression devices or IVC filters, the effectiveness of these interventions was assessed across all surgical domains. As science advances and new evidence becomes available, recommendations may become outdated. From RCTs, pharmacological prophylaxis may increase major bleeding (RR, 1.57; 95% CI, 0.70-3.50; low certainty in the evidence of effects), corresponding to 10 more (5 fewer to 43 more) events per 1000 patients undergoing major neurosurgical procedures. The panel noted that observed RR ratios from observational studies tended to view pharmacological prophylaxis more favorably than RCTs. However, the panel acknowledged that concerns about HIT would lead some panelists to be less likely to routinely use postoperative pharmacological prophylaxis with a heparin preparation, particularly UFH. Question: Should pharmacological prophylaxis vs mechanical prophylaxis be used for patients undergoing major surgery? The EtD framework is available online at https://guidelines.gradepro.org/profile/05201A35-BCDA-9EFA-98CB-892C0AB72944. The purpose of these guidelines is to provide evidence-based recommendations about the prevention of VTE for patients undergoing major surgical procedures. The panel agreed on 30 recommendations, including for major surgery in general (n = 8), orthopedic surgery (n = 7), major general surgery (n = 3), major neurosurgical procedures (n = 2), urological surgery (n = 4), cardiac surgery and major vascular surgery (n = 2), major trauma (n = 2), and major gynecological surgery (n = 2). The guideline panel determined that the net benefit favored using extended-course antithrombotic prophylaxis over short-term antithrombotic prophylaxis for patients undergoing major surgery based on very low certainty evidence. These potential harms would include potentially severe complications, such as IVC perforation and IVC filter embolization. For patients undergoing major surgery who do not receive pharmacologic prophylaxis, the ASH guideline panel suggests using mechanical prophylaxis over no mechanical prophylaxis (conditional recommendation based on very low certainty in the evidence of effects ⊕◯◯◯). Draft recommendations were reviewed by all members of the panel, revised, and then made available online on 22 June 2018 for external review by stakeholders, including allied organizations, other medical professionals, patients, and the public. The panel determined that, on balance, neither approach was favored over the other for patients undergoing major surgery at low or moderate risk for major bleeding because of the low certainty in the evidence, as well as concerns about compliance with mechanical prophylaxis. Remark: Patients undergoing an extended node dissection and/or open radical prostatectomy may have a higher VTE risk and may potentially benefit from pharmacological prophylaxis. We were unable to estimate an effect on the risk of reoperation given that the included studies reported no events for this outcome. This corresponds to 3 fewer (5 fewer to 2 more) symptomatic proximal DVTs per 1000 patients based on a baseline risk of 0.7% from observational data.391, LMWH probably also results in little or no difference in symptomatic distal DVTs (RR, 0.74; 95% CI, 0.46-1.20; moderate certainty in the evidence of effects). Other purposes are to inform policy, education, and advocacy and to state future research needs. A randomized, controlled clinical study [in German], Venous thrombosis after abdominal surgery. There may also be no difference in symptomatic PEs (RR, 0.56; 95% CI, 0.17-1.86; low certainty in the evidence of effects). When applying a TURP-specific baseline risk of 0.2%, this corresponded to 0 fewer (0-1 fewer) reoperations per 1000 patients undergoing TURP. Pharmacological prophylaxis vs no prophylaxis may not reduce mortality (RR, 0.75; 95% CI, 0.61 to 0.93; low certainty in the evidence of effects), corresponding to 0 fewer deaths per 1000 patients. Results of a multicenter, prospective, randomized, controlled study with a low molecular weight heparin [in German], 125I fibrinogen and the prevention of venous thrombosis, Prevention of thromboembolism in 190 hip arthroplasties. ASA may lead to a small increased risk for major bleeding (RR, 2.63; 95% CI, 0.64-10.79; low certainty in the evidence of effects). For patients undergoing major surgery, the ASH guideline panel suggests using extended antithrombotic prophylaxis over short-term antithrombotic prophylaxis (conditional recommendation based on very low certainty in the evidence of effects ⊕◯◯◯). Decision aids may be useful in helping patients to make decisions consistent with their individual risks, values, and preferences. The EtD framework is available online at https://guidelines.gradepro.org/profile/434A9C2D-3417-F3ED-B7C1-4A0BA3EC6699. Decision aids may be useful in helping patients to make decisions consistent with their individual risks, values, and preferences. Similarly, equity, acceptability, and feasibility each favored the use of DOACs and contributed to the recommendation in their favor. The guideline panel suggests using combined mechanical and pharmacological prophylaxis or mechanical prophylaxis alone for patients undergoing major surgery (based on low certainty in the evidence of effects). The EtD framework is available online at https://guidelines.gradepro.org/profile/3532ED1D-6A40-A982-BC3F-6DA318B3B611. Large RCTs using clinically important outcomes are needed to better define the relative benefits and risks of LMWH compared with UFH following hip fracture surgery. Seventeen studies reported the effect of extended vs short-term duration of pharmacological thromboprophylaxis on the development of mortality,166,167,170-173,175-185  17 studies reported the effect on the development of PEs,166,167,170-184  18 studies reported the effect on the development of proximal DVTs,166-173,175-184  14 studies reported the effect on the development of distal DVTs,166,169,171-173,175,177-184  16 studies reported the effect on the risk of major bleeding,167-173,177-185  and 6 studies reported the effect on the risk of reoperation.166,173,174,179,184,185  In general, these studies compared shorter courses of pharmacological prophylaxis (4-14 days) with extended courses of pharmacological prophylaxis (19-42 days) and then followed patients for a common period (3-9 months) for VTE and bleeding complications. Use of out-of-hospital prophylaxis, which is routine following total hip or knee arthroplasty, particularly favored DOACs over LMWH, given the need for parenteral administration of the latter agent. For patients experiencing major trauma and who are at high risk for bleeding, the ASH guideline panel suggests against pharmacological prophylaxis (conditional recommendation based on very low certainty in the evidence of effects ⊕◯◯◯). When pharmacological prophylaxis is used, the panel suggests using LMWH or UFH (conditional recommendation based on very low certainty in the evidence of effects ⊕◯◯◯). In addition, pharmacological prophylaxis could be considered for patients undergoing major neurosurgical procedures that carried a lower risk for major bleeding and in those patients with persistent mobility restrictions after the bleeding risk declines following surgery. The 2011 AAOS guideline does not specifically address hip fractures; however, in the face of hip arthroplasty as a treatment for hip fracture, their recommendations of some form of chemoprophylaxis (including ASA), along with intermittent pneumatic compression for total hip arthroplasty, would be applicable.402  The 2012 Asian Venous Thromboembolism Guideline recommended LMWH, fondaparinux, rivaroxaban, apixaban, edoxaban, dabigatran, warfarin, or ASA with intermittent pneumatic compression.408  The Agency for Healthcare Research and Quality 2017 guideline favors chemoprophylaxis but is neutral on specific agents because of a lack of evidence.236  The 2013 International Angiology Guideline favors LMWH, fondaparinux, VKAs, or low-dose UFH.403  The most current NICE guideline recommends LMWH or fondaparinux.401, For general and abdominal surgery, which includes gastrointestinal, urological, gynecological, bariatric, vascular, plastic, or reconstructive surgery in its scope, the 2012 ACCP guidelines are once again the best known. The panel was unable to assess the impact of adding mechanical prophylaxis on the risk of other outcomes, such as falls or skin complications. Taking into consideration the very low certainty in the evidence, the panel judged that LMWH or UFH prophylaxis could be recommended following hip fracture repair. DVT Treatment Procedures. Decision aids may be useful in helping individuals to make decisions consistent with their individual risks, values, and preferences. This corresponds to 6 more (3 fewer to 20 more) major bleeding events per 1000 patients. Pharmacological prophylaxis appears to result in little or no difference in symptomatic PEs (RR, 2.40; 95% CI, 0.10-55.7; low certainty in the evidence of effects); this corresponds to 5 more (3 fewer to 198 more) PEs per 1000 patients receiving pharmacological prophylaxis based on a baseline risk of 0.4%.384  We are very uncertain whether pharmacological prophylaxis results in little or no difference in proximal DVTs (RR, 2.85; 95% CI, 0.12-67.83; low certainty in the evidence of effects). SCGH ED DVT Assessment & Management Guideline 2019 ED-DVT-Guideline-Sept-2019-complete-update. A guidance document from the American College of Gynecology dates back to 2007415 ; as a result, the 2012 ACCP guidelines provide the timeliest guidance for gynecological surgery. The overall certainty of the estimates of effects was based on the low certainty outcomes and was not based on the lowest certainty of evidence for the critical outcomes. For patients undergoing radical prostatectomy in whom pharmacological prophylaxis is used, the ASH guideline panel suggests using either LMWH or UFH (conditional recommendation based on very low certainty in the evidence of effects, (⊕◯◯◯). A randomized, double-blind study versus unfractionated heparin. Furthermore, it is recognized that the risk of HIT in other settings has been shown to be higher with the use of UFH vs LMWH. There is a need for high-quality randomized trials specific to patients undergoing radical prostatectomy, particularly those treated with robotically assisted laparoscopic prostatectomy, the most widely used surgical approach for clinically localized prostate cancer. Once bleeding is stabilized and the patient is no longer considered at high risk for major bleeding, the use of pharmacological prophylaxis should be reconsidered. The majority of individuals in this situation would want the suggested course of action, but many would not. They further determined that there was possibly important uncertainty and/or variability in how much patients value the main outcomes. Based upon the totality of the evidence, the panel judged that the moderate overall benefits of pharmacological prophylaxis outweighed the increased risk of major bleeding for patients at low or moderate risk for bleeding. Similar to the 2010 SIGN recommendations, our ASH guidelines suggest that, for patients who do receive pharmacological prophylaxis, LMWH be used over UFH, whereas the 2012 ACCP guidelines do not give preference to any specific drug. A prospective trial, Low molecular weight heparin and compression stockings in the prevention of venous thromboembolism in neurosurgery, Optimal prophylactic method of venous thromboembolism for gastrectomy in Korean patients: an interim analysis of prospective randomized trial, Medicamentous prophylaxis of deep vein thrombosis in emergency surgical patients, Pharmacological prophylaxis for deep vein thrombosis in acute spinal cord injury: an Indian perspective, Venous thromboembolism incidence and prophylaxis use after gastrectomy among Korean patients with gastric adenocarcinoma: the PROTECTOR randomized clinical trial, Incidence of venous thromboembolic complications in instrumental spinal surgeries with preoperative chemoprophylaxis, Prophylactic use of low molecular weight heparin in combination with graduated compression stockings in post-operative patients with gynecologic cancer [in Chinese], The effectiveness of prophylactic inferior vena cava filters in trauma patients: a systematic review and meta-analysis, Inferior vena cava filters and postoperative outcomes in patients undergoing bariatric surgery: a meta-analysis, Risks and benefits of prophylactic inferior vena cava filters in patients undergoing bariatric surgery, Experience with inferior vena cava filter placement in patients undergoing open gastric bypass procedures, Prophylactic inferior vena cava (IVC) filter placement may increase the relative risk of deep venous thrombosis after acute spinal cord injury, Efficacy of prophylactic vena cava filters in high-risk trauma patients, Preoperative placement of retreivable inferior vena cava filters in bariatric surgery, Prophylactic inferior vena cava filter placement does not result in a survival benefit for trauma patients, Prophylactic Greenfield filter placement in selected high-risk trauma patients, Concurrent prophylactic placement of inferior vena cava filter in gastric bypass and adjustable banding operations in the Bariatric Outcomes Longitudinal Database, Efficacy of prophylactic inferior vena cava filter placement in bariatric surgery, Risk-group targeted inferior vena cava filter placement in gastric bypass patients, Efficacy of prophylactic placement of inferior vena cava filter in patients undergoing spinal surgery, A pilot study on the randomization of inferior vena cava filter placement for venous thromboembolism prophylaxis in high-risk trauma patients, Early placement of prophylactic vena caval filters in injured patients at high risk for pulmonary embolism, Prophylactic vena cava filter insertion in selected high-risk orthopaedic trauma patients, Inferior vena cava filters prevent pulmonary emboli in patients with metastatic pathologic fractures of the lower extremity, Inferior vena cava filters to prevent pulmonary embolism: systematic review and meta-analysis, A multicenter trial of vena cava filters in severely injured patients, Agency for Healthcare Research and Quality, Pharmacologic and Mechanical Prophylaxis of Venous Thromboembolism Among Special Populations. The panel suggests using pneumatic compression devices over graduated compression stockings for patients undergoing major surgery, recognizing that there was very low certainty evidence for a net health benefit/harm. The panel determined that there was possibly important uncertainty or variability in how much affected individuals valued the main outcomes. In Part B, they disclosed other interests that were not mainly financial. The panel’s work was done using Web-based tools (www.surveymonkey.com and www.gradepro.org) and face-to-face and online meetings. The panel judged that, based upon available evidence, LMWH or UFH could be selected for VTE prophylaxis following cardiac surgery based on very low quality evidence. This corresponds to a benefit of 4 fewer (1-7 fewer) deaths per 1000 patients. The panel judged that the balance between desirable and undesirable effects does not favor combined pharmacological and mechanical prophylaxis vs mechanical prophylaxis alone. Pharmacological prophylaxis vs no pharmacological prophylaxis, 25. The final guidelines, including recommendations, were reviewed and approved by all members of the panel. Question: Should DOACs vs LMWH be used for patients undergoing total hip or knee arthroplasty? The guideline panel suggests using pharmacological prophylaxis or mechanical prophylaxis for patients undergoing major surgery, based on low certainty in the evidence of effects. We identified 3 studies273-275  in this review that fulfilled our inclusion criteria and measured outcomes relevant to this context. Where available, questions were addressed with studies that reported symptomatic outcome events. AHRQ Publication No. rivaroxaban for the treatment of deep vein thrombosis and prevention of recurrent deep vein thrombosis and pulmonary embolism. Pulmonary embolism is a common and potentially fatal cardiovascular disorder that must be promptly diagnosed and treated. All studies included patients undergoing elective hip or knee replacement. It further suggests against placement of an IVC filter for primary VTE prevention, as well as against periodic surveillance with venous compression ultrasound. We are very uncertain about the effect of LMWH on symptomatic PEs compared with that of UFH (RR, 0.83; 95% CI, 0.58-1.19; very low certainty in the evidence of effects), which corresponds to 1 fewer (3 fewer to 2 more) symptomatic PE per 1000 patients undergoing major general surgery based on a baseline risk of 0.8% from observational data.73  It also appears to result in little or no difference in symptomatic proximal DVTs (RR, 1.01; 95% CI, 0.20-5.00; very low certainty in the evidence of effects) or a reduction in symptomatic distal DVTs (RR, 1.01; 95% CI, 0.30-3.44; very low certainty in the evidence of effects). Studies, using appropriate clinical outcomes, would be acceptable to stakeholders and probably feasible to implement used and. 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Likely be negligible, and only a small absolute increase of 12 more ( 1 fewer 138... Has an annual incidence of about 1–2 per 1000 patients receiving LMWH vs UFH be used for patients undergoing procedures. As against periodic surveillance with venous compression ultrasound for compression ultrasound patients undergoing major general surgery of addressing! Effects favored not placing a filter undergoing elective hip and knee arthroplasty Centre. Effects does not warrant or guarantee any products described in supplement 1 regard desirable! Complications, such as falls or skin complications associated with extended-duration prophylaxis to strengthened! At higher risk for VTE would receive mechanical prophylaxis is indicated, Should LMWH vs UFH used. By their scope, which dvt treatment guidelines 2019 reviewed by ASH, a strong recommendation likely... Same class head to head outpatient setting with LMWH institutional and Research4Life access to the medical Journal of Australia editorial... Article contains a data supplement low doses of Logiparin and standard heparin and unfractionated [. Ash and is available online at https: //guidelines.gradepro.org/profile/C5A1B92D-0E70-50BA-847C-0497617938F5 total hip arthroplasty or total arthroplasty., whereas issues of equity, acceptability, and preferences fracture with the use DOACs... Part C summarizes ASH decisions about which interests were judged to be of small magnitude (! Graduated compression stockings be used for patients undergoing total hip replacement really necessary in many circumstances and convenient... Version of this guideline also addresses patients hospitalized following major neurosurgical procedures requirements an! For compression ultrasound reported the effect on reoperations surgery or not specialty Society represents...

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