Please note that this is app an abridged version of the complete guidelines, the electronic version of which is available on the following website: www.haematology.org.my

STATEMENT OF INTENT

These guidelines are meant to be a guide for clinical practice, based on the best available evidence at the time of development. Adherence to these guidelines may not necessarily ensure the best outcome in every case. Every health care provider is responsible for the management options available locally.

REVIEW OF THE GUIDELINES

These guidelines were issued in 2013 and will be reviewed in 2017 or sooner if new evidence becomes available.

DISCLOSURE STATEMENT

The panel members had completed disclosure forms. None held shares in pharmaceutical firms or acted as consultants to such firms (details are available upon request from the CPG Secretariat).

SOURCES OF FUNDING

The development of the CPG on Prevention and Treatment of Venous Thromboembolism was supported via unrestricted educational grant from Bayer Healthcare Pharmaceuticals. The funding body has not influenced the development of the guidelines.

GUIDELINES DEVELOPMENT

The development group for these guidelines consists of Haematologist, Cardiologist, Neurologist, Obstetrician & Gynaecologist, Vascular Surgeon, Orthopaedic Surgeon, Anaesthesiologist, Pharmacologist and Pharmacist from the Ministry of Health Malaysia, Ministry of Higher Education Malaysia and the Private sector.

Literature search was carried out at the following electronic databases: International Health Technology Assessment website, PUBMED, MEDLINE, Cochrane Database of Systemic Reviews (CDSR), Journal full text via OVID search engine and Science Direct. In addition, the reference lists of studies selected for inclusion were scanned for relevant studies.

The clinical questions were divided into 18 subgroups and members of the development workgroup were assigned individual topics. Literature searched were appraised by workgroup members using Critical Appraisal Skills Programme (CASP) checklist, presented in the form of evidence table and discussed during group meetings. All statements and recommendations formulated were agreed by both the development group and review committee. Where the evidence was insufficient, the recommendations were derived by consensus of the development group and review committee.

The articles were graded by using the National Guidelines Clearinghouse (www.guidelines.gov), Agency for Healthcare Research and Quality, U.S. Department of Health & Human Services, USA, level of evidence while the grading of recommendations in these guidelines was modified from the Scottish Intercollegiate Guidelines Network (SIGN). Refer to Appendix 12 for further details.

These guidelines have been presented to the Technical Advisory Committee for Clinical Practice Guidelines and the Health Technology Assessment and Clinical Practice Guidelines Council, Ministry of Health Malaysia for review and approval.

OBJECTIVES

GENERAL OBJECTIVES

To provide evidence-based guidance in the management of venous thromboembolism.

SPECIFIC OBJECTIVES

It is not the objective of these guidelines to cover:

o Management of arterial thrombosis

TARGET POPULATION

All patients with VTE or at risk for VTE

CLINICAL QUESTIONS

Refer to appendix 13

TARGET GROUP/ USER

All health care professionals

GUIDELINES DEVELOPMENT GROUP

Chairperson

Professor Dr Abdul Rashid Abdul Rahman

Consultant Physician and Clinical Pharmacologist

Cyberjaya Unviversity College of Medical Sciences and Hospital Pakar An Nur

Co-Chairperson

Dr Jameela Sathar

Consultant Haematologist

Ampang Hospital

Members (alphabetical order)

Chong Chia Chee

Pharmacist

Ampang Hospital

Dr Eeson Sinthamoney

Consultant Obstetrician & Gynaecologist

Pantai Hospital Kuala Lumpur

Dr Hamat Hamdi Che Hassan

Consultant Cardiologist

Hospital Universiti Kebangsaan Malaysia

Assoc Professor Dr Hanafiah Harunarashid

Consultant Vascular Surgeon

Hospital Universiti Kebangsaan Malaysia

Dr Kiren Sidhu

Consultant Obstetrician & Gynaecologist

Pantai Hospital Kuala Lumpur

Assoc Professor Dr Mohammad Hassan Shukur

Consultant Orthopaedic and Trauma Surgeon

Hospital Universiti Kebangsaan Malaysia

Dr Santhi Datuk Puvanarajah

Consultant Neurologist

Hospital Kuala Lumpur

Dr Shanti Rudra Deva

Consultant Intensivist

Hospital Kuala Lumpur

Professor Dr Woo Yin Ling

Consultant Obstetrician & Gynaecologist

University Malaya Medical Center

REVIEW COMMITTEE

The draft of these guidelines are reviewed by a panel of independent expert referees from both public and private sectors, who were asked to comment primarily on the comprehensiveness and accuracy of interpretation of the evidence supporting the recommendations in the guidelines.

Chairman

Dr Chang Kian Meng

Head of Haematology &

Consultant Haematologist

Department of Haematology

Ampang Hospital

Members (in alphabetical order)

Dr Fitzgerald Henry

Head of Surgery &

Consultant Surgeon

Department of Surgery

Selayang Hospital

Dr Jay Suriar

Consultant haematologist

Department of Haematology

Ampang Hospital

Dr Kauthaman a/l Mahendran

Head of Medicine

Consultant Physician

Department of Medicine

Malacca Hospital

Dr Liew Nyan Chin

Medical Officer

Department of Obstetrics & Gynaecology

Ampang Hospital

Dr Muralitharan Ganesalingam

Consultant Obstetrics & Gynaecology

Head of Department

Department of Obstetrics & Gynaecology

Ampang Hospital

Dr Salmiah Md Shariff

Family Medicine Specialist

Batu 9, Cheras Health Clinic

Dr Shekhar Krishnan

Consultant Paediatric Haematologist

Department of Paediatrics

University Malaya Medical Center

Dr Wan Hamilton bt Wan Hassan

Head and Consultant Obstetrician & Gynaecologist

Department of Obstetrics & Gynaecology

Serdang Hospital

Dr Wong Jun Ching

Medical Officer

Department of Obstetrics & Gynaecology

Ampang Hospital

Dr Zaharah Musa

Head of Radiology &

Consultant Radiologist

Department of Diagnostic Imaging

Hospital Selayang

Dr Zainal Ariffin Azizi

Head of Surgery &

Consultant Vascular Surgeon

Department of Surgery

Hospital Kuala Lumpur

EXTERNAL REVIEWERS

The following external reviewers provided feedback on the draft.

Professor Mike A Laffan

Professor of Haemostasis & Thrombosis

Department of Medicine

Imperial College, United Kingdom

Professor John Andrew Murie

Senior Consultant Vascular Surgeon, Royal Infirmary of Edinburgh

Honorary Senior Lecturer University of Edinburgh Medical School

Adjunct Professor, Universiti Kebangsaan Malaysia

Professor Paul Monagle

Head and Consultant Paediatric Haematologist

Department of Paediatrics

The University of Melbourne

Royal Children's Hospital

Victoria, Australia