Prevention Of Venous Thromboembolism Final
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international guidelines onvenous thromboembolism prenetion in critical care patients
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Prevention Of Venous Thromboembolism Final
- 1. Guidelines for Prevention of Venous Thromboembolism in Critical Care Patients D. Sandesc “ Victor Babes” University of Medicine and Pharmacy, Timisoara
- 3. Evidence-Based Clinical Practice Guidelines of the American College of Chest Physicians (8th Edition) *William H. Geerts, David Bergqvist, Graham F. Pineo, John A. Heit, Charles M. Samama, Michael R. Lassen and Clifford W. Colwell Chest 2008;133;381-453 DOI 10.1378/chest.08-0656 http :// chestjournal.org / cgi /content/abstract/133/6_ suppl /381S Downloaded from chestjournal.org on June 25, 2008 Prevention of Venous Thromboembolism
- 8. The majority of the postoperative episodes of VTE are undetectable 10 – 20% symptomatic 80 – 90% asymptomatic
- 9. Postoperative prophylaxis of the fatal PE using low dose unfractioned Heparin (Kakkar , Lancet , 1975) Number of patients with fatal PE p < 0.005 16 2 0 2 4 6 8 10 12 14 16 18 Control NFH Kakkar VV, et al. Lancet . 19 75 ;2: 45 Low doses of UFH save 7 lives each 1,000 patients who have undergone surgery. PE = Pulmonary Embolism; UFH = Unfractioned Heparin (N = 2,076) (N = 2,045)
- 13. Approximate Risks of DVT in Hospitalized Patients* * Rates based on objective diagnostic screening for asymptomatic DVT in patients not receiving thromboprophylaxis Patient Group DVT Prevalence, % Medical patients 10-20 General surgery 15-40 Major gynecologic surgery 15-40 Major urologic surgery 15-40 Neurosurgery 15-40 Stroke 20-50 Hip or knee arthroplasty, HFS 40-60 Major trauma 40-80 SCI 60-80 Critical care patients 10-80
- 14. Levels of Thromboemboli c Risk and Recommended Thromboprophylaxis in Hospital ized Patients *
- 19. Use of Antithrombotic Drugs for Prophylaxis in Patients with Renal Impairment 1 Clexane ® -Lovenox ® prescribing information. sanofi-aventis. 2 Fragmin ® prescribing information. Pfizer. 3 Innohep ® prescribing information. Pharmion. 4 Arixtra ® prescribing information. GlaxoSmithKline. Moderate (Cl Cr 30–50 mL/min) and mild renal impairment (Cl Cr 50–80 mL/min) Severe renal impairment (Cl Cr < 30 mL/min) Enoxaparin 1 No adjustment needed “ dose to be adjusted ” Dose is being specified. Dalteparin 2 No information available “ To be used with precaution” Dose is not being specified. Tinzaparin 3 No information available “ To be used with precaution” Dose is not being specified. Fondaparinux Used with precaution in moderate renal impairment “ Contraindicated”
- 20. Thromboprophylaxis and body weight 1 Clexane ® -Lovenox ® prescribing information. Sanofi-aventis. 2 Fragmin ® prescribing information. Pfizer. 3 Innohep ® prescribing information. Pharmion. 4 Arixtra ® prescribing information. GlaxoSmithKline. Men < 57 kg and Women < 45 kg) Obese (IMC 30–48 kg/m 2 ) Enoxaparin 1 No adjustment needed No adjustment needed Dalteparin 2 No information available No information available Tinzaparin 3 No information available No information available Fondaparinux “ Not if < 50 kg No information available