Venous Thromboembolism Prophylaxis in Surgical Patients

SUMMARY

Venous thromboembolism (VTE) prophylaxis in the surgical patient remains an important medical issue. Research has shown that VTE, which includes deep vein thrombosis and pulmonary embolism, occurs frequently in hospitalized patients who have undergone general, major gynecologic, major urologic, major orthopedic, or neurosurgery if preventive measures are not taken. Although it is impossible to predict with certainty which surgical patients will develop VTE, it is important for medical consultants to have a working knowledge of the different risk factors for VTE as well as current prophylaxis recommendations in order to employ appropriate strategies to reduce the risk of VTE. The following module discusses the clinical impact of VTE in surgical patients, reviews the various risk factors for VTE in surgical patients, and discusses prophylaxis options. In addition, goals for VTE prophylaxis and methods for evaluating when and how to initiate prophylaxis and determining the length of pharmacologic intervention are provided using recent research and the American College of Chest Physicians 2012 guidelines.

GOAL

To provide hospitalists with current data and guidelines regarding venous thromboembolism prophylaxis in surgical patients.

TARGET AUDIENCE

This activity is designed for hospitalists. 

LEARNING OBJECTIVES

After completing the module, the participant should be able to:

  1. Recognize the clinical impact of venous thromboembolism (VTE) on surgical patients.
  2. Describe the risk factors that increase the likelihood of developing a VTE and how to risk stratify surgical patients based on these factors.
  3. Formulate the goals of prophylactic intervention programs.
  4. Summarize the VTE prophylaxis regimens for general and abdominopelvic surgery patients.
  5. Summarize the VTE pharmacoprophylaxis regimens for major orthopedic surgery patients.
  6. Outline when to initiate VTE chemoprophylaxis and the current roles of extended VTE chemoprophylaxis.
CME INFORMATION

Accreditation Statement:
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of University of Virginia School of Medicine, ASiM, and the Society of Hospital Medicine. The University of Virginia School of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation Statement:
The University of Virginia School of Medicine designates this enduring material for a maximum of 2.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.


Release date: February 27, 2015.             Expiration date: February 27, 2018


Estimated time to complete activity: 2 hours

FACULTY & FACULTY DISCLOSURES

Full Disclosure Policy Affecting CME Activities:
The University of Virginia School of Medicine, as an ACCME accredited provider, endorses and strives to comply with the Accreditation Council for Continuing Medical Education (ACCME) Standards of Commercial Support, Commonwealth of Virginia statutes, University of Virginia policies and procedures, and associated federal and private regulations and guidelines on the need for disclosure and monitoring of proprietary and financial interests that may affect the scientific integrity and balance of content delivered in continuing medical education activities under our auspices.

The University of Virginia School of Medicine requires that all CME activities accredited through this institution be developed independently and be scientifically rigorous, balanced and objective in the presentation/discussion of its content, theories and practices.

All faculty presenters participating in an accredited CME activity are expected to disclose relevant financial relationships with commercial entities occurring within the past 12 months (such as grants or research support, employee, consultant, stock holder, member of speakers bureau, etc.). The University of Virginia School of Medicine will employ appropriate mechanisms to resolve potential conflicts of interest to maintain the standards of fair and balanced education to the participant. Questions about specific strategies can be directed to the Office of Continuing Medical Education, University of Virginia School of Medicine, Charlottesville, Virginia.

The faculty and staff of the University of Virginia Office of Continuing Medical Education have no financial affiliations to disclose.

Leonard Feldman, MD (Chair)
 Associate Professor of Medicine
Johns Hopkins University School of Medicine
Med-Peds Urban Health Residency Program Director
Associate Program Director, Osler Medical Residency
Director, Comprehensive General Medicine Consult Service
Editor, Consultative, and Perioperative Medicine Essentials for Hospitalists
Baltimore, Maryland
Dr Feldman reports having no significant financial or advisory relationships with corporate organizations related to this activity.
 
Charles Locke, MD
Assistant Professor, School of Medicine
Division of General Internal Medicine,
Johns Hopkins University School of Medicine
Baltimore, Maryland
Dr Locke reports having no significant financial or advisory relationships with corporate organizations related to this activity.

Michael Streiff, MD
Associate Professor, Division of Hematology
Department of Medicine
Johns Hopkins University School of Medicine
Baltimore, Maryland
Dr Streiff reports receiving research support from Portola Pharmaceuticals, Inc; and receiving honoraria from Boehringer Ingelheim Pharmaceuticals, Inc, Daiichi Sankyo Company, Ltd, Janssen Healthcare, and Pfizer Inc.
 
Bartho Caponi, MD (Peer Reviewer)
Clinical Assistant Professor
Division of Hospital Medicine
University of Wisconsin Hospital and Clinics
Madison, Wisconsin
Dr Caponi reports having no significant financial or advisory relationships with corporate
organizations related to this activity.
 
Disclosure of Discussion of Non-FDA–Approved Uses for Pharmaceutical Products and/or Medical Devices
The University of Virginia School of Medicine, as an ACCME provider, requires that all faculty presenters identify and disclose any off-label uses for pharmaceutical and medical device products. The University of Virginia School of Medicine recommends that each physician fully review all the available data on new products or procedures prior to clinical use.
 
Off-Label Product Discussion:
Dr Locke reports discussing the following commercial products or services: apixaban, dabigatran, fondaparinux, low-molecular-weight heparin, rivaroxaban, and unfractionated heparin.

Dr Streiff reports discussing the following commercial products or services: use of low-molecular-weight heparin, unfractionated heparin in VTE prophylaxis, and perioperative bridging anticoagulation and the use of fondaparinux and rivaroxaban in VTE prophylaxis.
 
DISCLAIMER
The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of the University of Virginia School of Medicine name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combination of drugs, including indications, contraindications, warnings and adverse effects before administering pharmacologic therapy to patients.
 
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INSTRUCTIONS
The following is an interactive educational module designed to help you gauge your basic knowledge of the topic and then direct you to areas you may need to focus on. It consists of 3 sections: an unaccredited pre-test, a study program, and a CME post-test. All 3 sections must be completed to receive CME credit.
 

This activity is supported by independent educational grants from Boehringer Ingelheim Pharmaceuticals, Inc, Bristol-Myers Squibb Company, and Pfizer Inc.

 
Course summary
Available credit: 
  • 2.00 AMA PRA Category 1 Credit™
  • 2.00 Equivalent Credit
Course opens: 
02/27/2015
Course expires: 
02/27/2018
Cost:
$0.00
Parent activity set: 
Rating: 
0

Available Credit

  • 2.00 AMA PRA Category 1 Credit™
  • 2.00 Equivalent Credit

Accreditation Period

Course opens: 
02/27/2015
Course expires: 
02/27/2018

Price

Cost:
$0.00
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