Surgery News - September 2008 - (Page 6) 6 S U R G E R Y NEWS • S E P T E M B E R 2 0 0 8 THE THE E 20/20 / 0/20 B Y B E T S Y B AT E S V SION O SIO SION IO New Guidelines Update Strategies for Thrombosis Prevention, Management manage thrombosis in surgical patients and special risk groups, including pregnant women, children, obese patients, and patients with prosthetic heart valves or a history of cardiovascular disease or stroke. Compiled by more than 90 experts, the 700 recommendations run more than 1,000 pages, although a 38-page executive summary is available (Chest 2008;133:71S109 [doi:10.1378/chest.08-0693]). Among the most noteworthy recommendations is a renewed call for venous thromboembolism (VTE) prophylaxis of most hospitalized patients. The new recommendations for VTE prophylaxis include bariatric and coronary artery bypass surgery. The length of recommended postsurgical prophylaxis has been extended from the previously recommended 2-week period to 28 days (and in some cases to 35 days) for most general, gynecologic, and orthopedic procedures, noted Dr. Geno J. Merli, chief medical officer of Thomas Jefferson University Hospital, Philadelphia. A new chapter expands evidencebased guidance for perioperative management of patients on antithrombotic therapy who need emergency or elective surgery. Detailed sections provide advice for circumstances ranging from minor dermatologic surgery to hip fracture. “This [publication] is not meant to be read from cover to cover,” said Dr. Jack Hirsh in an interview. “It is an encyclopedic reference to be used by physicians if the patient has had a stroke, is at risk of stroke, has had a heart attack, is at risk of heart attack, has atrial fibrillation, has an inherited thrombophilia, or is pregnant and on antithrombotic therapy,” said Dr. Hirsch, professor emeritus of medicine at McMaster University and founding director of the Henderson Research Center, both in Hamilton, Ont. The guidelines offer two options—one monitored and one unmonitored—for subcutaneous heparin administration for acute DVT, Dr. Merli said in an interview. The first regimen calls for an initial dose of 17,500 U or a weight-adjusted dose of about 250 U/kg every 12 hours, with the dose adjusted to achieve and maintain an activated partial thromboplastin time (aPTT) prolongation that corresponds to plasma heparin levels of 0.3-0.7 IU/mL anti-Xa activity when measured 6 hours after injection (rather than beginning therapy with the smaller initial dose). The second option is a fixed-dose, unmonitored regimen that calls for an initial dose of 333 U/kg followed by a twice-daily dose of 250 U/kg. The guidelines also suggest the use of catheter-directed thrombolysis with thrombus fragmentation and/or aspiration in “selected patients with extensive acute proximal DVT who have a low risk of bleeding,” but advocate this pharmacomechanical approach only if “appropriate expertise and resources are available.” The guidelines also say that INR monitoring during anticoagulation therapy may be reduced in very low risk patients with an unprovoked DVT, Dr. Merli noted. ■ Else vier Global Medical Ne ws weeping new clinical guidelines issued by the American College of Chest Physicians provide updated recommendations on how to prevent and S 3% commodities allocation NEW FUND ALLOCATION A 3% commodities allocation has been added to SDIF in an effort to further align its asset allocation with that of the ACS endowment. The commodities component allows SDIF shareholders to obtain exposure to various types of commodities, including industrial and precious metals, agriculture, livestock and energy. Commodities exposure adds an asset class to SDIF that provides further diversification, and one that historically has a negative correlation to stocks and bonds. For more information about SDIF, please contact Tom Kiley at 312/202-5019, tkiley@facs.org, or Savi Pai at 312/202-5056, spai@facs.org. An investor should consider the charges, risks, expenses and investment objective carefully before investing. For more information or for a free copy of the prospectus, please download a copy at www.surgeonsfund.com or call 1-800-208-6070 and a copy will be mailed to you. Read the prospectus carefully before you invest or send money. SDIF is distributed by Ultimus Fund Distributors, LLC, 225 Pictoria Dr., Suite 450, Cincinnati, OH 45246. The phone number is 513-587-3400. http://www.surgeonsfund.com http://www.surgeonsfund.com
Table of Contents Feed for the Digital Edition of Surgery News - September 2008 Surgery News - September 2008 Contents Appreciation Low Scores News From the College: New Leader Practice Trends: High Price to Pay Surgery News - September 2008 Surgery News - September 2008 - Contents (Page 1) Surgery News - September 2008 - Contents (Page 2) Surgery News - September 2008 - Contents (Page 3) Surgery News - September 2008 - Appreciation (Page 4) Surgery News - September 2008 - Low Scores (Page 5) Surgery News - September 2008 - Low Scores (Page 6) Surgery News - September 2008 - Low Scores (Page 7) Surgery News - September 2008 - News From the College: New Leader (Page 8) Surgery News - September 2008 - News From the College: New Leader (Page 9) Surgery News - September 2008 - News From the College: New Leader (Page 10) Surgery News - September 2008 - Practice Trends: High Price to Pay (Page 11) Surgery News - September 2008 - Practice Trends: High Price to Pay (Page 12) Surgery News - September 2008 - Practice Trends: High Price to Pay (Page 13) Surgery News - September 2008 - Practice Trends: High Price to Pay (Page 14) Surgery News - September 2008 - Practice Trends: High Price to Pay (Page 15) Surgery News - September 2008 - Practice Trends: High Price to Pay (Page 16)
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