TY - JOUR
T1 - Venous thromboembolism prevention in emergency general surgery a review
AU - Murphy, Patrick B.
AU - Vogt, Kelly N.
AU - Lau, Brandyn D.
AU - Aboagye, Jonathan
AU - Parry, Neil G.
AU - Streiff, Michael B.
AU - Haut, Elliott R.
N1 - Funding Information:
supported by grant 1R01HS024547 from the Agency for Healthcare Research & Quality titled “Individualized Performance Feedback on Venous Thromboembolism Prevention Practice,” by contract CE-12-11-4489 from the Patient-Centered Outcomes Research Institute (PCORI) titled “Preventing Venous Thromboembolism: Empowering Patients and Enabling Patient-Centered Care via Health Information Technology,” and by contract CE-12-11-4489 from PCORI titled “Preventing Venous Thromboembolism (VTE): Engaging Patients to Reduce Preventable Harm from Missed/Refused Doses of VTE Prophylaxis.” Mr Lau is supported by the Institute for Excellence in Education Berkheimer Faculty Education Scholar Grant and contract AD-1306-03980 from the Patient-Centered Outcomes Research Institute entitled “Patient Centered Approaches to Collect Sexual Orientation/Gender Identity Information in the Emergency Department.”
Publisher Copyright:
© 2018 American Medical Association.
PY - 2018/5
Y1 - 2018/5
N2 - IMPORTANCE Venous thromboembolism (VTE) is the most preventable cause of morbidity and mortality in US hospitals, and approximately 2.5%of emergency general surgery (EGS) patients will be diagnosed with a VTE event. Emergency general surgery patients are at increased risk of morbidity and mortality because of the nature of acute surgical conditions and the challenges related to prophylaxis. OBSERVATIONS MEDLINE, Embase, and the Cochrane Database of Collected Reviews were searched from January 1, 1990, through December 31, 2015. Nearly all operatively and nonoperatively treated EGS patients have a moderate to high risk of developing a VTE, and individual risk should be assessed at admission. Pharmacologic prophylaxis in the form of unfractionated or low-molecular-weight heparin should be considered unless an absolute contraindication, such as bleeding, exists. Patients should receive the first dose at admission to the hospital, and administration should continue until discharge without missed doses. Certain patient populations, such as those with malignant tumors, may benefit from prolonged VTE prophylaxis after discharge. Mechanical prophylaxis should be considered in all patients, particularly if pharmacologic prophylaxis is contraindicated. Studies that specifically target improved adherence with VTE prophylaxis in EGS patients suggest that efficacy and quality improvement initiatives should be undertaken from a system and institutional perspective. CONCLUSIONS AND RELEVANCE Operatively and nonoperatively treated EGS patients are at a comparatively high risk of VTE. Despite gaps in existing literature with respect to this increasing patient population, successful best practices can be applied. Best practices include assessment of VTE risk, optimal prophylaxis, and physician, nurse, and patient education regarding the use of mechanical and pharmacologic VTE prophylaxis and institutional policies.
AB - IMPORTANCE Venous thromboembolism (VTE) is the most preventable cause of morbidity and mortality in US hospitals, and approximately 2.5%of emergency general surgery (EGS) patients will be diagnosed with a VTE event. Emergency general surgery patients are at increased risk of morbidity and mortality because of the nature of acute surgical conditions and the challenges related to prophylaxis. OBSERVATIONS MEDLINE, Embase, and the Cochrane Database of Collected Reviews were searched from January 1, 1990, through December 31, 2015. Nearly all operatively and nonoperatively treated EGS patients have a moderate to high risk of developing a VTE, and individual risk should be assessed at admission. Pharmacologic prophylaxis in the form of unfractionated or low-molecular-weight heparin should be considered unless an absolute contraindication, such as bleeding, exists. Patients should receive the first dose at admission to the hospital, and administration should continue until discharge without missed doses. Certain patient populations, such as those with malignant tumors, may benefit from prolonged VTE prophylaxis after discharge. Mechanical prophylaxis should be considered in all patients, particularly if pharmacologic prophylaxis is contraindicated. Studies that specifically target improved adherence with VTE prophylaxis in EGS patients suggest that efficacy and quality improvement initiatives should be undertaken from a system and institutional perspective. CONCLUSIONS AND RELEVANCE Operatively and nonoperatively treated EGS patients are at a comparatively high risk of VTE. Despite gaps in existing literature with respect to this increasing patient population, successful best practices can be applied. Best practices include assessment of VTE risk, optimal prophylaxis, and physician, nurse, and patient education regarding the use of mechanical and pharmacologic VTE prophylaxis and institutional policies.
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U2 - 10.1001/jamasurg.2018.0015
DO - 10.1001/jamasurg.2018.0015
M3 - Review article
C2 - 29541758
AN - SCOPUS:85047193998
VL - 153
SP - 479
EP - 486
JO - JAMA Surgery
JF - JAMA Surgery
SN - 2168-6254
IS - 5
ER -