VTE Prophylaxis - Who Really Needs It? Who Can Likely Go Without. What Are the Best Options? (2026 CCHM)
Learning Objectives:
- Apply Validated Risk Assessment Models to Stratify Medical Patients: Utilize the Padua and IMPROVE scores to assess VTE risk in medically ill patients. Use the Caprini score for surgical patients to balance the risk of thrombosis against bleeding complications.
- Compare Prophylaxis Strategies • LMWH vs. UFH: Low Molecular Weight Heparin (LMWH) is generally superior to Unfractionated Heparin (UFH) for prophylaxis, except in patients with severe renal failure (CrCl <30 mL/min). • Mechanical Prophylaxis: Use Intermittent Pneumatic Compression (IPC) or Graduated Compression Stockings (GCS) when pharmacologic prophylaxis is contraindicated due to high bleeding risk.
- Implement Updated Cancer-Associated VTE Guidelines • ASCO Updates: Recent guidelines support the use of direct oral anticoagulants (DOACs) like apixaban and rivaroxaban for both the treatment of established VTE and extended thromboprophylaxis in cancer patients. • Bleeding Caution: Exercise caution with DOACs in patients with GI and genitourinary malignancies due to a higher risk of mucosal bleeding.
Timothy J. Barreiro, DO, MPH, FCCP, MACOI, FACP
Section Chair Pulmonary, Critical care and Sleep Medicine
NEOMED, LECOM, OUHCOM
As a Professor of Internal Medicine, Timothy J. Barreiro has demonstrated determination for working and caring for the underserved and has a commitment and appreciation for diversity, education, and mentoring. He has coached hundreds of residents going into leadership and fellowship positions. He obtained his Doctorate of Osteopathy from Ohio University Heritage College of Osteopathic Medicine in Athens, OH. He went on to specialty training in pulmonary, critical care, and sleep at the University of Rochester School of Medicine & Dentistry. It was early in his career path where he as entitled Health Disparities Scholar, National Center on Minority Health & Health Disparities, by the Department of Health & Human Services Public Health Service, National Institute of Health for his work on cultural complexities in health care.
Dr. Barreiro is committed to improving patient care through his preventable lung disease program and research in health disparities. He is the author and co-author of over 80 peer-reviewed publications. He is severed over 10 years as a Health Commissioner for the Office of Minority Health as appointed by the Governor of Ohio. He is a CMS appointee on the Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) Advisory committee. He is a founding member of the task force recently commissioned by the AOA to the Committee of Equity and Advancement with American College of Osteopathic Interns. His multidisciplinary clinic is the only pulmonary office to serve the uninsured in the city of Youngstown, Ohio. He is a member of numerous professional societies where he serves in leadership and advisory positions. He has achieved Master Fellow at the College of Osteopathic Interns. Dr. Barreiro has two grandchildren. He enjoys literature and the humanities, writes for the DO magazine.
The faculty member, for this activity, has no relevant relationships with ineligible companies to disclose.