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Thrombosis Guidelines Emphasize Difficult Choices for Pregnant Women
Date:6/24/2008

tic therapy until underlying causes can be determined, followed by maintenance therapy to prevent long-term recurrence. In addition, the newly expanded guidelines on the prevention and treatment of thrombosis related to congenital heart disease interventions include discussions of ventricular assist devices and prosthetic heart valves.

"Care for children with major cardiac problems has improved dramatically. Many children who previously died now survive, but thrombosis remains a major cause of secondary complications for these children," said Dr. Hirsh. "Effective antithrombotic therapy is critical if these children are to grow up as normal, healthy children."

Patients Undergoing Surgery

For the first time, the guidelines dedicate a full chapter to the perioperative management of patients on long-term antithrombotic therapy who require surgery or other invasive procedures. Most patients must temporarily stop receiving therapy just prior to undergoing surgery, as well as during surgery, in order to minimize surgery-related bleeding. However, stopping antithrombotic therapy can increase the risk of a thromboembolic event. To address this challenge, the guidelines recommend that the risk of a thromboembolic event during interruption of therapy is balanced against the risk for bleeding when antithrombotic therapy is discontinued just prior to surgery. The guidelines also recommend routine use of thromboprophylaxis for patients undergoing major general, gynecologic, or orthopedic surgeries and have been expanded to include bariatric and coronary artery bypass surgery.

General Recommendations

Overall, ACCP guidelines recommend thromboprophylaxis for most patients who are hospitalized; however, they do not recommend routine use of thromboprophylaxis for patient groups with a very low risk of venous thromboembolism. Low risk groups include patients undergoing laparoscopic surgery, knee arthroscopy, or those who take long airplane flights.
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SOURCE American College of Chest Physicians
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