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William H. Geerts, MD, FCCP; Graham F. Pineo, MD; John A. Heit, MD; David Bergqvist, MD, PhD, FRCS; Michael R. Lassen,

Developed by a panel of 87 physicians Published CHEST Sept 2004 supplementIntroduces novel therapies for prevention/treatment of thrombosis Emphasizes need for stronger implementation in the clinical setting. 7th ACCP Conference on Antithrombotic

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William H. Geerts, MD, FCCP; Graham F. Pineo, MD; John A. Heit, MD; David Bergqvist, MD, PhD, FRCS; Michael R. Lassen,

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    2. Developed by a panel of 87 physicians Published CHEST Sept 2004 supplement Introduces novel therapies for prevention/treatment of thrombosis Emphasizes need for stronger implementation in the clinical setting 7th ACCP Conference on Antithrombotic & Thrombolytic Therapy

    3. Grade 1 Recommendations

    4. Grade 2 Recommendations

    5. General Recommendations Use mechanical methods of prophylaxis primarily in patients at high risk of bleeding (Grade 1C+), or as an adjunct to anticoagulant-based prophylaxis (Grade 2A) Direct careful attention toward ensuring proper use of, and optimal compliance with, the mechanical device (Grade 1C+) We recommend against the use of aspirin alone as prophylaxis of VTE for any patient group (Grade 1A)

    6. General Surgery (1)

    7. General Surgery (2)

    8. General Surgery (3)

    9. Vascular Surgery In patients with no additional risk factors for thromboembolism, we suggest clinicians do not routinely use thromboprophylaxis (Grade 2B) For patients with additional thromboembolic risk factors who are undergoing major vascular surgery, we recommend low-dose unfractionated heparin (LDUH) or LMWH (Grade 1C+)

    10. Gynecologic Surgery (1)

    11. Gynecologic Surgery (2)

    12. Gynecologic Surgery (3)

    13. Orthopaedic Surgery - Hip

    14. Orthopaedic Surgery - Knee

    15. Orthopaedic Surgery hip fracture

    16. Orthopaedic Surgery duration Total hip or knee replacement, or hip-fracture surgery: LMWH (high-risk dose), fondaparinux (2.5 mg/d), or a VKA (target INR 2.5; range, 2.0 to 3.0) for = 10 d (Grade 1A) Total hip replacement or hip-fracture surgery: extended prophylaxis (= 28 to 35 d) after surgery (Grade 1A), as follows: total hip replacement: LMWH (Grade 1A), a VKA (Grade 1A), or fondaparinux (Grade 1C+); hip-fracture surgery: fondaparinux (Grade 1A), LMWH (Grade 1C+), or a VKA (Grade 1C+)

    17. Orthopaedic Surgery - other We recommend basing a decision about when to initiate pharmacologic prophylaxis on the efficacy-to-bleeding tradeoffs for that agent (Grade 1A). LMWH therapy can be started preoperatively or postoperatively (Grade 1A) We recommend against routine duplex ultrasonography screening at hospital discharge in asymptomatic patients after major orthopedic surgery (Grade 1A)

    18. Elective Spinal Surgery

    19. Neurosurgery

    20. Trauma

    21. Acute Spinal Cord Injury

    22. Other Conditions

    23. Application of the ACCP Guidelines In theory, dissemination of evidence-based guidelines derived from systematic reviews should result in more-informed decision-making and improved patient outcomes Despite their widespread dissemination, however, the application of the ACCP antithrombotic guidelines in practice remains incomplete

    24. Implementation Strategies: to increase uptake of guidelines

    25. Implementation Strategies: to increase uptake of guidelines

    26. Implementation Strategies: Additional recommendations We recommend devoting appreciable resources to distributing educational material to encourage the use of guidelines to reduce thrombosis (Grade 2B) We suggest that few resources be devoted to educational meetings (Grade 2B), to audit and feedback (Grade 2B), and to educational outreach visits (Grade 2B) to encourage implementation of the guidelines We suggest devoting appreciable resources to computer reminders (Grade 2A) and to patient-mediated interventions (Grade 2B)

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