Guidelines for Treatment of Thrombosis Updated

June 24, 2008

The American College of Chest Physicians has published updated guidelines for the prevention, treatment and management of thrombosis in populations such as pregnant women, children and hospitalized patients in a supplement to the June issue of Chest.

TUESDAY, June 24 (HealthDay News) -- The American College of Chest Physicians (ACCP) has published updated guidelines for the prevention, treatment and management of thrombosis in populations such as pregnant women, children and hospitalized patients in a supplement to the June issue of Chest.

For women who are pregnant or wish to become pregnant while undergoing long-term antithrombotic therapy, the guidelines recommend that vitamin K antagonists such as warfarin be stopped before six weeks of fetal gestation for most women, as they can cause birth defects or miscarriage. Low-molecular-weight heparin or unfractionated heparin should be substituted prior to conception or a confirmed pregnancy, although these are more expensive and long-term use is associated with osteoporosis.

The guidelines recommend the routine use of thromboprophylaxis for patients undergoing major general, gynecologic, orthopedic, bariatric and coronary artery bypass surgery. In general, the guidelines recommend thromboprophylaxis for most hospitalized patients, except those at very low risk of venous thromboembolism such as patients undergoing laparoscopic surgery or knee arthroscopy, or those who take long airplane flights.

Children with arterial ischemic stroke should receive initial antithrombotic therapy until the cause of the stroke is identified, followed by maintenance treatment to prevent recurrence. "Care for children with major cardiac problems has improved dramatically. Many children who previously died now survive, but thrombosis remains a major cause of secondary complications for these children," said Jack Hirsh, M.D., from the Henderson Research Center in Hamilton, Ontario, Canada. "Effective antithrombotic therapy is critical if these children are to grow up as normal, healthy children."

Antithrombotic and Thrombolytic Therapy: ACCP Evidence-Based Clinical Practice Guidelines, Eighth Edition was developed by an international panel of 90 experts chaired by Hirsh.

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