Summary
Venous thromboembolism occurs in a significant number of patients in typical risk situations (e.g. surgery or trauma). However, in these special highrisk situations anticoagulants, particularly low molecular weight heparin, allow for a decrease in the number of venous thromboses, pulmonary embolisms and deaths caused by pulmonary embolism. Only the wide-spread and adequate use of antithrombotics can safeguard against venous thromboembolism in these various risk situations. Guidelines constitute an integrative part of quality management and ensure the application of evidence-based medicine. The present consensus on thrombosis prophylaxis in Austria has been elaborated by 23 experts in the fields of hemostasis research, angiology, surgery, orthopedics, internal medicine, anaesthesiology and pharmacology. The recommendations for the management of thrombosis prophylaxis in the fields of general surgery, orthopaedic and trauma surgery and internal medicine have been elaborated drawing on the Guidelines issued by the American College of Chest Physicians. Included are recommendations on indications as well as the choice of antithrombotics, dose and duration of therapy for the various conditions. The Austrian Guidelines for Venous Thromboembolism Prophylaxis are meant to be a basis for standardising procedures in the above-mentioned fields, thus contributing to an improved management of risk situations by physicians and health care staff and providing more safety for patients.
Zusammenfassung
Venöse Thromboembolien treten bei einem bedeutenden Anteil von Patienten in typischen Risikosituationen (z.B. Operation oder Trauma) auf. Durch gerinnungshemmende Medikamente, insbesondere die niedermolekularen Heparine, ist es möglich, die Anzahl an venösen Thrombosen, Pulmonalembolien und Tod durch Pulmonalembolie in diesen speziellen Risikosituationen zu senken. Nur die breite und richtige Anwendung von Antithrombotika stellt sicher, dass die Patienten in den jeweiligen Risikosituationen effektiv vor venösen Thromboembolien geschützt werden. Leitlinien (Guidelines) sind integrativer Bestandteil des Qualitätsmanagements und stellen die Anwendung evidenzbasierter Medizin sicher. Der Konsensus zur Durchführung der Thromboseprophylaxe in Österreich wurde von 23 Experten aus dem Gebiet der Hämostaseologie, Angiologie, Chirurgie, Orthopädie, Inneren Medizin, Anästhesiologie und Pharmakologie erarbeitet. Basierend auf den Guidelines des American College of Chest Physicians wurden die Vorschläge für die Durchführung der Thromboseprophylaxe auf den Gebieten Allgemeinchirurgie, Orthopädische Chirurgie, Unfallchirurgie und Innere Medizin erarbeitet. Es werden die Indikationen, die Art der Antithrombotika, Dosis und Dauer in den verschiedenen Indikationen vorgeschlagen. Die Erstellung der Österreichischen Leitlinien für die Venöse Thromboembolieprophylaxe soll durch eine Harmonisierung des Vorgehens ein größeres Maß an Sicherheit in Organisationsstrukturen für den Arzt, den Pflegebereich und den Patienten schaffen.
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Literatur
Cardiovascular Disease Educational and Research Trust; Cyprus Cardiovascular Disease Educational and Research Trust; European Venous Forum; International Surgical Thrombosis Forum; International Union of Angiology; Union Internationale de Phlebologie (2006) Prevention and treatment of venous thromboembolism. International Consensus Statement (guidelines according to scientific evidence). Int Angiol 25 (2): 101–161
Cohen AT, Davidson BL, Gallus AS, et al (2006) Efficacy and safety of fondaparinux for the prevention of venous thromboembolism in older acute medical patients. Randomized placebo controlled trial (ARTEMIS). BMJ 332: 325–329
Cohen AT, et al (2007) A large-scale, global observational study of venous thromboembolism risk and prophylaxis in the acute hospital care setting: the ENDORSE study. XXIst Conference of the ISTH, July, Geneva, abstr 0-S-002
Colwell CW Jr, Kwong LM, Turpie AG, Davidson BL (2006) Flexibility in administration of fondaparinux for prevention of symptomatic venous thromboembolism in orthopaedic surgery (FLEXTRA Study). J Arthroplasty 21: 36–45
Eriksson BI, Lassen MR, PENTHIFRA Plus Study: For the Pentasaccharide in Hip-fracture Surgery Plus (PENTHIFRA Plus) Investigators (2003) Duration of prophylaxis against venous thromboembolism fondaparinux after Hip-fracture Surgery: A multi-center, randomized, placebo-controlled, double blind study. Arch Intern Med 163: 1337–1342
Geerts WH, Pineo GF, Heit JA, Bergqvist D, Lassen MR, Colwell CW, Ray JG (2004) Prevention of venous thromboembolism: the seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest, Sep 126: 338S–400S
Geerts WH (2007) Personal communication
Guyatt G, Gutterman D, Baumann MH, Addrizzo-Harris D, Hylek EM, Phillips B, Raskob G, Zelman Lewis S, Schünemann H (2006) Grading strength of recommendations and quality of evidence in clinical guidelines: report from an american college of chest physicians task force. Chest 129: 174–181
Ritschl P, Hochreiter J, Kotz R, Krismer M, Niessner H, Schwarz B, Windhager R; unter Patronanz der Österreichischen Gesellschaft für Orthopädie und Orthopädische Chirurgie (2007) Thromboseprophylaxe in der orthopädischen Chirurgie. Österreichische Ärztezeitung [Suppl]: 1–8
Hull RD, et al (2007) Extended-duration venous thromboembolism (VTE) prophylaxis in acutely ill medical patients with recent reduced mobility: the EXCLAIM study. XXIst Conference of the ISTH, Geneva, abstr. 0-S-001
Leizorovic A, Cohen AT, Turpie AG, et al (2004) Randomized, placebo-controlled trial of dalteparin for the prevention of venous thromboembolism in acutely ill medical patients (PREVENT). Circulation 110: 8749
Lindblad B, Sternby NH, Bergqvist D (1991) Incidence of venous thromboembolism verified by necropsy over 30 years. BMJ 302: 709–711
Nelzén O, Bergqvist D, Lindhagen A, Hallböök T (1991) Chronic leg ulcers: an underestimated problem in primary health care among elderly patients. J Epidemiol Community Health 45: 184–187
Nordström M, Lindblad B, Bergqvist D, Kjellström T (1992) A prospective study of the incidence of deep-vein thrombosis within a defined urban population. J Intern Med 232: 155–160
Turpie AG, Bauer KA, Eriksson BI, Lassen MR (2002) Fondaparinux vs enoxaparin for the prevention of venous thromboembolism in major orthopaedic surgery. A metaanalysis of 4 randomized double blind studies. Arch Intern Med 162: 1833–1840
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Pabinger, I., Eichinger, S., Minar, E. et al. Leitlinien für die venöse Thromboembolieprophylaxe in Österreich. Wien Klin Wochenschr 119, 739–746 (2007). https://doi.org/10.1007/s00508-007-0915-z
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DOI: https://doi.org/10.1007/s00508-007-0915-z