ACP Guidelines: Hospital VTE Prophylaxis Should Not Be Universal

In considering prophylaxis for venous thromboembolism in hospitalized nonsurgical patients, the American College of Physicians (ACP) recommends assessing patients' risks for bleeding before proceeding. In a review of randomized trials, published in the Annals of Internal Medicine, researchers found that while low-dose heparin may have reduced pulmonary embolism, it increased bleeding events and had no significant effect on mortality. Clinical outcomes did not differ between low-molecular-weight heparin and unfractionated heparin. The researchers interpret their findings as "indicative of little or no net benefit" from heparin prophylaxis. On that basis, the ACP's guidelines committee recommends the following for medical (including stroke) patients:

Perform an individualized assessment of VTE and bleeding risks before starting prophylaxis. Use pharmacologic prophylaxis unless bleeding risks outweigh likely benefits. Do not use compression stockings for prophylaxis.

From a policy standpoint, the committee argues against use of performance measures that mandate universal VTE prophylaxis, regardless of patients' individual risks for harm.
http://firstwatch.jwatch.org/cgi/content/full/2011/1101/1?q=pfw

Published in Physician's First Watch November 1, 2011