After a risk assessment consider pharmacological prophylaxis with: |
ACP |
Moderate-quality evidence moderately confident in the effect estimate: the true effect is likely close to the estimated effect, but there is a sizable possibility that it is substantially different |
Strong |
Low Molecular Weight Heparin
|
ACCP |
GRADE 1B |
Strong |
(ACCP, NHMRC, SIGN, AWMF, ASH and NICE) |
Randomized controlled trials with important limitations (inconsistent results, methodologic flaws, indirect or imprecise) or very strong evidence from observational studies |
Unfractionated heparin
|
NHRMC |
Body of evidence can be trusted to guide practice in most situations |
B |
(ACP, ACCP, NHMRC, SIGNa; ASHc), |
SIGN |
At least one meta-analysis, systematic review, or randomized controlled trials rated as 1++ and directly applicable to the target population; or a body of evidence consisting principally of studies rated as 1+, directly applicable to the target population, and demonstrating overall consistency of result |
A |
Fondaparinux
|
AWMF |
High quality of evidence (systematic review with or without meta-analysis or randomized controlled trials) |
Strong |
(ACCP, SIGNa, AWMFb, ASHc, NICEd) |
ASH |
Low certainty in the evidence of effects (certainty in these estimated effects was rated as very low owing to risk of bias and imprecision of the estimates) |
Conditional (suggest) |
|
NICE |
No specification |
Strong |
For acutely ill hospitalized medical patients at low risk of thrombosis, the recommendation is not to use pharmacologic prophylaxis or mechanical prophylaxis based on the Padua Prediction Score |
ACCP |
GRADE 1B |
Strong |
Randomized controlled trials with important limitations (inconsistent results, methodologic flaws, indirect or imprecise) or very strong evidence from observational studies |
For acutely ill hospitalized medical patients who are bleeding or at high risk for bleeding, the recommendation is not to use anticoagulant thromboprophylaxis based on the Padua Prediction Score |
ACCP |
GRADE 1B |
Strong |
Randomized controlled trials with important limitations (inconsistent results, methodologic flaws, indirect or imprecise) or very strong evidence from observational studies |
Aspirin is not recommended as the sole pharmacological agent for venous thromboembolism prophylaxis in medical patients |
SIGN |
A body of evidence including studies rated as 2+, directly applicable to the target population and demonstrating overall consistency of results; or extrapolated evidence from studies rated as 2++ |
C |
Medical patients hospitalized for acute illness are recommended Low Molecular Weight Heparin over Direct Oral Anticoagulants for venous thromboembolism prophylaxis |
ASH |
Moderate certainty in the evidence of effects (certainty in these estimated effects was moderate owing to imprecision of the estimates for the VTE outcomes) |
Strong |
Drug prophylaxis for patients should generally last 6 to 14 days. |
ACCP |
GRADE 2B |
Weak |
Evidence from randomized controlled trials with important limitations (inconsistent results, methodologic flaws, indirect or imprecise) or very strong evidence from observational studies. |
AWMF |
Moderate |
Recommended |
Randomized controlled trials or cohort studies of limited quality |
NICE |
No specificatione
|
Strong |
Recommends inpatient over inpatient plus extended-duration outpatient venous thromboembolism prophylaxis with heparin and direct oral anticoagulants |
ASH |
Moderate certainty in the evidence of effects certainty in these estimated effects was low owing to imprecision of the estimates and indirect comparisons) |
Strong |