Venous thromboembolism (VTE) prophylaxis in the surgical patient remains an important medical issue. Research has shown that VTE, which includes deep vein thrombosis and pulmonary embolism, occurs frequently in hospitalized patients who have undergone general, major gynecologic, major urologic, major orthopedic, or neurosurgery if preventive measures are not taken. Although it is impossible to predict with certainty which surgical patients will develop VTE, it is important for medical consultants to have a working knowledge of the different risk factors for VTE as well as current prophylaxis recommendations in order to employ appropriate strategies to reduce the risk of VTE. The following module discusses the clinical impact of VTE in surgical patients, reviews the various risk factors for VTE in surgical patients, and discusses prophylaxis options. In addition, goals for VTE prophylaxis and methods for evaluating when and how to initiate prophylaxis and determining the length of pharmacologic intervention are provided using recent research and the American College of Chest Physicians 2008 guidelines.

To provide hospitalists with current data and guidelines regarding venous thromboembolism prophylaxis in surgical patients.

This activity is designed for hospitalists. No prerequisites required.

After completing the module, the participant should be able to:

1. Recognize the clinical impact of venous thromboembolism (VTE) on surgical patients.
2. Describe the risk factors that increase the likelihood of developing a VTE.
3. Formulate the goals of prophylactic intervention programs.
4. Summarize the various VTE prophylaxis regimens available today.
5. Assess current controversies in prophylaxis for major orthopedic procedures.
6. Propose when to initiate VTE prophylaxis and when extended prophylaxis may be appropriate.
7. Outline the new anticoagulants for VTE prophylaxis.
8. Design strategies to improve VTE prophylaxis at your institution.

The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.

Accreditation Statement: The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation Statement: The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 2 AMA PRA Category 1 Credit(s)^™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Release date: August 15, 2009. Expiration date: August 15, 2011.

Estimated time to complete activity: 2 hours

Full Disclosure Policy Affecting CME Activities: As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of The Johns Hopkins University School of Medicine to require the disclosure of the existence of any relevant financial interest or any other relationship a faculty member or a provider has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The presenting faculty reported the following:

^*Assistant Professor, School of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.

^†Associate Professor, Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.

^‡Assistant Professor, School of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Conflict of Interest: Dr Locke and Dr Feldman report having no relevant financial or advisory relationships with corporate organizations related to this activity; Dr Streiff reports receiving grants/research support from Bristol-Myers Squibb and honoraria from Medical Communications Media.

Off-Label Product Discussion: All faculty have indicated that they have not referenced unlabeled or unapproved uses of drugs or devices.

Disclaimer: The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of The Johns Hopkins University School of Medicine name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combination of drugs, including indications, contraindications, warnings and adverse effects before administering pharmacologic therapy to patients.

Address correspondence to: Leonard Feldman, MD, Assistant Professor, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Park Building Room 307, 600 North Wolfe Street, Baltimore, MD 21287. E-mail: LennyF@jhmi.edu..

Click here to download the references for this educational activity.

The following is an interactive educational module designed to help you gauge your basic knowledge of the topic and then direct you to areas you may need to focus on. It consists of 3 sections: an unaccredited pre-test, a study activity, and a CME post-test. All 3 sections must be completed to receive CME credit.

Supported by an educational grant from Merck & Co., Inc.