Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.202300672
Jornal Vascular Brasileiro
Review Article

Evidence-based pharmacological prophylaxis recommendations for venous thromboembolism in hospitalized acutely ill medical patients: a systematic review of clinical practice guidelines

Recomendações baseadas em evidências científicas de profilaxia farmacológica para tromboembolismo venoso em pacientes hospitalizados com doenças agudas: uma revisão sistemática de diretrizes clínicas

Ana Paula Callejo de Souza; Franciele Cordeiro Gabriel; Géssica Caroline Henrique Fontes-Mota; Mariana de Siqueira Silva; Eliane Ribeiro

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Abstract

Abstract: Venous thromboembolism is a complex multifactorial disease considered the most common cause of preventable deaths in hospitalized patients. Recommendations about pharmacological venous thromboembolism prophylaxis in adult hospitalized patients are available in clinical practice guidelines for optimization of healthcare delivery and improvement of patient outcomes. We conducted a systematic review of clinical practice guidelines using ADAPTE to synthesize recommendations for pharmacological prophylaxis of venous thromboembolism in hospitalized medical patients at a medium complexity university hospital. Recommendations for pharmacological prophylaxis were extracted from seven clinical practice guidelines considered of high quality after assessment with the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. These recommendations will support discussion with specialists and implementation of practices in the setting of the hospital studied.

Keywords

venous thromboembolism, anticoagulants, practice guideline, hospitals, patient care, systematic review

Resumo

Resumo: O tromboembolismo venoso é uma doença multifatorial complexa, considerada uma causa comum de óbitos evitáveis em pacientes hospitalizados. Recomendações sobre profilaxia farmacológica de tromboembolismo venoso em pacientes adultos hospitalizados estão disponíveis em diretrizes clínicas para otimizar os cuidados à saúde e contribuir com a melhora do desfecho do paciente. Dessa forma, foi conduzida uma revisão sistemática de diretrizes clínicas utilizando a metodologia ADAPTE para sintetizar as recomendações para profilaxia farmacológica de tromboembolismo venoso em pacientes clínicos adultos hospitalizados em um hospital universitário de média complexidade. As recomendações para profilaxia farmacológica foram extraídas de sete diretrizes clínicas consideradas de alta qualidade após avaliação pelo Appraisal of Guidelines for Research and Evaluation (AGREE II). Essas recomendações servirão de apoio para discussão com especialistas e implementação de práticas dentro do contexto do hospital estudado.
 

Palavras-chave

tromboembolia venosa, anticoagulantes, guia de prática clínica, hospitais, assistência ao paciente, revisão sistemática

References

1 Cohen AT, Tapson VF, Bergmann JF, et al. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet. 2008;371(9610):387-94. http://dx.doi.org/10.1016/S0140-6736(08)60202-0. PMid:18242412.

2 Lutsey PL, Zakai NA. Epidemiology and prevention of venous thromboembolism. Nat Rev Cardiol. 2023;20(4):248-62. http://dx.doi.org/10.1038/s41569-022-00787-6. PMid:36258120.

3 Geerts WH, Heit JA, Clagett GP, et al. Prevention of venous thromboembolism. Chest. 2001;119(1, Suppl Suppl):132S-75S. http://dx.doi.org/10.1378/chest.119.1_suppl.132S. PMid:11157647.

4 Labarere J, Bosson JL, Pernod G. Incorrect use of thromboprophylaxis for venous thromboembolism in medical and surgical patients: results of a multicentric, observational, and cross-sectional study in Brazil. J Thromb Haemost. 2006;4(12):2737-8. http://dx.doi.org/10.1111/j.1538-7836.2006.02215.x. PMid:16981888.

5 Institute of Medicine. Committee on Standards for Developing Trustworthy Clinical Practice Guidelines. Clinical practice guidelines we can trust. Washington, DC: National Academies Press (US); 2011.

6 Fervers B, Carretier J, Bataillard A. Clinical practice guidelines. J Visc Surg. 2010;147(6):e341-9. http://dx.doi.org/10.1016/j.jviscsurg.2010.10.010. PMid:21093403.

7 Schünemann HJ, Wiercioch W, Brozek J, et al. GRADE Evidence to Decision (EtD) frameworks for adoption, adaptation, and de novo development of trustworthy recommendations: GRADE-ADOLOPMENT. J Clin Epidemiol. 2017;81:101-10. http://dx.doi.org/10.1016/j.jclinepi.2016.09.009. PMid:27713072.

8 Schünemann HJ, Fretheim A, Oxman AD. Improving the use of research evidence in guideline development: 13. Applicability, transferability and adaptation. Health Res Policy Syst. 2006;4(1):25. http://dx.doi.org/10.1186/1478-4505-4-25. PMid:17156457.

9 Graham ID, Harrison MB. Evaluation and adaptation of clinical practice guidelines. Evid Based Nurs. 2005;8(3):68-72. http://dx.doi.org/10.1136/ebn.8.3.68. PMid:16021701.

10 ADAPTE Collaboration. Guideline adaptation: a resource Toolkit [Internet]. 2009 [cited 2023 Apr 17]. https://g-i-n.net/wp-content/uploads/2021/03/ADAPTE-Resource-toolkit-March-2010.pdf

11 Amer YS, Elzalabany MM, Omar TI, Ibrahim AG, Dowidar NL. The “Adapted ADAPTE”: an approach to improve utilization of the ADAPTE guideline adaptation resource toolkit in the Alexandria Center for Evidence-Based Clinical Practice Guidelines. J Eval Clin Pract. 2015;21(6):1095-106. http://dx.doi.org/10.1111/jep.12479. PMid:26662728.

12 Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372(71):n71. http://dx.doi.org/10.1136/bmj.n71. PMid:33782057.

13 Conselho Nacional de Secretários de Saúde. Assistência de média e alta complexidade no SUS. Brasília: CONASS; 2007.

14 Brasil. Ministério da Saúde. Portaria SAS/MS nº 1083, de 02 de outubro de 2012. Protocolo clínico e diretrizes terapêuticas: dor crônica. Diário Oficial da União; 2012 [cited 2023 Mar 10]. https://bvsms.saude.gov.br/bvs/saudelegis/sas/2012/prt1083_02_10_2012.html.

15 Brasil. Ministério da Saúde. Portaria no 1.266, de 14 de novembro de 2014. Protocolo clínico e diretrizes terapêuticas da Doença de Gaucher. Diário Oficial da União; 2014 [cited 2023 Mar 10]. https://bvsms.saude.gov.br/bvs/saudelegis/sas/2014/prt1266_14_11_2014.html.

16 National Institute of Health and Care Excellence. Obesity prevention [Internet]. 2006 [cited 2023 Mar 10]. https://www.nice.org.uk/guidance/cg43/resources/obesity-prevention-975445344709.

17 Bahn RS, Burch HB, Cooper DS, et al. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid. 2011;21(6):593-646. http://dx.doi.org/10.1089/thy.2010.0417. PMid:21510801.

18 AGREE Enterprise. AGREE enterprise website [Internet]. 2023 [cited 2023 July 27]. www.agreetrust.org

19 Hoffmann-Eßer W, Siering U, Neugebauer EAM, Lampert U, Eikermann M. Systematic review of current guideline appraisals performed with the Appraisal of Guidelines for Research & Evaluation II instrument—a third of AGREE II users apply a cut-off for guideline quality. J Clin Epidemiol. 2018;95:120-7. http://dx.doi.org/10.1016/j.jclinepi.2017.12.009. PMid:29288133.

20 Joint Working Group. Guidelines for the diagnosis, treatment and prevention of pulmonary thromboembolism and deep vein thrombosis (JCS 2009). Circ J. 2011;75(5):1258-81. http://dx.doi.org/10.1253/circj.CJ-88-0010. PMid:21441695.

21 Meza-Reyes GE, Cymet-Ramírez J, Esquivel-Gómez R, et al. Declaración de posición conjunta del Colegio Mexicano de Ortopedia y Traumatología: Profilaxis de la enfermedad tromboembólica venosa en cirugía ortopédica de alto riesgo. Acta Ortop Mex. 2011;25(4):216-22. PMid:22509643.

22 Qaseem A, Chou R, Humphrey LL, Starkey M, Shekelle P. Venous thromboembolism prophylaxis in hospitalized patients: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2011;155(9):625-32. http://dx.doi.org/10.7326/0003-4819-155-9-201111010-00011. PMid:22041951.

23 Kahn SR, Lim W, Dunn AS, et al. Prevention of VTE in nonsurgical patients. Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e195S-e226S. http://dx.doi.org/10.1378/chest.11-2296.

24 Wickham N, Gallus AS, Walters BNJ, Wilson A. Prevention of venous thromboembolism in patients admitted to Australian hospitals: summary of National Health and Medical Research Council clinical practice guideline. Intern Med J. 2012;42(6):698-708. http://dx.doi.org/10.1111/j.1445-5994.2012.02808.x. PMid:22697152.

25 Nicolaides AN, Fareed J, Kakkar AK, et al. Prevention and treatment of venous thromboembolism: international consensus statement. Int Angiol. 2013;32(2):111-260. PMid:24402349.

26 Vázquez FJ, Lifschitz E, Watman R, et al. Guía de recomendaciones para la profilaxis de la enfermedad tromboembólica venosa en adultos en la Argentina. Medicina (B Aires). 2013;73(Suppl 2):1-26. PMid:24192583.

27 Malaysia. Ministry of Health Malaysia. Prevention and treatment of venous thromboembolism [Internet]. Malaysia: Ministry of Health Malaysia; 2013. [cited 2023 Mar 10]. https://www.moh.gov.my/moh/attachments/9005.pdf

28 Scottish Intercollegiate Guidelines Network. Prevention and management of venous thromboembolism: a national clinical guideline [Internet]. Edinburgh: SIGN; 2010 [cited 2023 Mar 10]. https://www.sign.ac.uk/media/1060/sign122.pdf

29 Encke A, Haas S, Kopp I. The prophylaxis of venous thromboembolism. Dtsch Arztebl Int. 2016;113(31-32):532-8. PMid:27581506.

30 Al-Hameed FM, Al-Dorzi HM, Abdelaal MA, et al. The saudi clinical practice guideline for the prophylaxis of venous thromboembolism in medical and critically ill patients. Saudi Med J. 2016;37(11):1279-93. http://dx.doi.org/10.15537/smj.2016.11.15268. PMid:27761572.

31 National Guideline Centre. Venous thromboembolism in over 16s: Reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism. London: NICE; 2018.

32 Queensland Government. Guideline for the prevention of Venous Thromboembolism (VTE) in adult hospitalised patients [Internet]. 2018 [cited 2023 Mar 10]. https://www.health.qld.gov.au/__data/assets/pdf_file/0031/812938/vte-prevention-guideline.pdf.

33 Schünemann HJ, Cushman M, Burnett AE, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: Prophylaxis for hospitalized and nonhospitalized medical patients. Blood Adv. 2018;2(22):3198-225. http://dx.doi.org/10.1182/bloodadvances.2018022954. PMid:30482763.

34 Mahan CE, Spyropoulos AC. ASHP therapeutic position statement on the role of pharmacotherapy in preventing venous thromboembolism in hospitalized patients. Am J Health Syst Pharm. 2012;69(24):2174-90. http://dx.doi.org/10.2146/ajhp120236. PMid:23289165.

35 Ageno W, Hunt BJ. Reducing the burden of venous thromboembolism in the acute medically ill population with extended-duration thromboprophylaxis. Eur Heart J Suppl. 2018;20(Suppl E):E6-11. http://dx.doi.org/10.1093/eurheartj/suy015. PMid:29977163.

36 Turpie AG. Thrombosis prophylaxis in the acutely ill medical patient: insights from the prophylaxis in MEDical patients with ENOXaparin (MEDENOX) trial. Am J Cardiol. 2000;86(12B):48M-52M. http://dx.doi.org/10.1016/S0002-9149(00)01481-8 PMid:11206019.

37 Leizorovicz A, Cohen AT, Turpie AG, Olsson CG, Vaitkus PT, Goldhaber SZ. Randomized, placebo-controlled trial of dalteparin for the prevention of venous thromboembolism in acutely ill medical patients. Circulation. 2004;110(7):874-9. http://dx.doi.org/10.1161/01.CIR.0000138928.83266.24. PMid:15289368.

38 Cohen AT, Davidson BL, Gallus AS, et al. ARTEMIS Investigators. Efficacy and safety of fondaparinux for the prevention of venous thromboembolism in older acute medical patients: randomised placebo controlled trial. BMJ. 2006;332(7537):325-9. http://dx.doi.org/10.1136/bmj.38733.466748.7C. PMid:16439370.

39 Hull RD, Schellong SM, Tapson VF, et al. Extended-duration thromboprophylaxis in acutely ill medical patients with recent reduced mobility: methodology for the EXCLAIM study. J Thromb Thrombolysis. 2006;22(1):31-8. http://dx.doi.org/10.1007/s11239-006-7732-5. PMid:16786230.

40 Goldhaber SZ, Leizorovicz A, Kakkar AK, et al. Apixaban versus Enoxaparin for thromboprophylaxis in medically ill patients. N Engl J Med. 2011;365(23):2167-77. http://dx.doi.org/10.1056/NEJMoa1110899. PMid:22077144.

41 Cohen AT, Spiro TE, Büller HR, et al. Rivaroxaban for thromboprophylaxis in acutely ill medical patients. N Engl J Med. 2013;368(6):513-23. http://dx.doi.org/10.1056/NEJMoa1111096. PMid:23388003.
 


Submitted date:
04/19/2023

Accepted date:
06/06/2023

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
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