The prevention and management of venous thromboembolic disease is a huge topic, which generates questions for emergency, critical care, and acute physicians during many shifts:
- How long should someone requiring cardioversion for atrial fibrillation be anticoagulated for?
- How should I provide thromboprophylaxis for this intubated patient?
- This patient with submassive pulmonary embolism isn’t hypotensive yet. Can I thrombolyse them? Can I?
- There’s a large superficial vein thrombosis in that limb – is anticoagulation indicated?
- This asymptomatic patient on warfarin has an INR of 9.0 – should I reverse them?
- Do I need to add Vitamin K if I’ve reversed warfarin with prothrombin complex concentrate?
The answers to these – and many, many more – questions are provided in one of the most comprehensive guidelines I’ve ever come across. I can see myself clicking on the link below in future when on duty in the ED.
Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
Chest. 2012 Feb;141(2 Suppl) Full Text