Venous Thromboembolism Prophylaxis in Surgical Patients - No CME Available


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.


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


This activity is designed for hospitalists. 


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.

This activity currently does not have any CME available. The series SHM Consults is reviewing all content and will publish an accredited module based on this topic when available.

Estimated time to complete activity: 2 hours

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 an unaccredited post-test. 
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Leonard Feldman, MD (Chair)
 Associate Professor of MedicineJohns 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 relevant 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 relevant 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 relevant financial or advisory relationships with corporate
organizations related to this activity.
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.

In accordance with the ACCME Standards for Commercial Support, SHM requires that individuals in a position to control the content of an educational activity disclose all relevant financial relationships with any commercial interest. SHM resolves all conflicts of interest to ensure independence, objectivity, balance, and scientific rigor in all its educational programs. All relevant financial relationships shall be disclosed to participants prior to the start of the activity.

Furthermore, SHM seeks to verify that all scientific research referred to, reported, or used in a continuing medical education (CME) activity conforms to the generally accepted standards of experimental design, data collection, and analysis. SHM is committed to providing its learners with high-quality CME activities that promote improvements in healthcare and not those of a commercial interest.

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