**7. Conclusion**

This systematic review analyzed the methodological quality and summarized the main recommendations of the CPGs for pharmacological prophylaxis of VTE in adult hospitalized surgical and medical patients.

Seven CPGs were considered with high-quality after assessment by AGREE II a tool accepted as a gold standard for guideline evaluation. The scores with a cut-off of 60% or more for domains 3 (rigor of development) and 6 (editorial independence) were used to identify high-quality CPGs in this study. Domain 3 indicates minimum bias and evidence-based guideline development and domain 6 indicates the relevance of conflict of guideline authors as a potential source of bias. Special attention should be directed to domain 5 (applicability) which indicates the description of barriers and facilitators that impact the applicability of the guideline and had an average score of a 41%. The findings, by presenting the weaknesses in the method's rigor, can also help developers to improve the quality of future CPGs.

Regarding the scope addressed by the guidelines, it was identified that the topics were included regarding important aspects in pharmacological prophylaxis of VTE in hospitalized patients. Most CPGs included recommendations about drug, dose, and duration of therapy that were summarized in the indication and strategy of pharmacological prophylaxis.

The high-quality CPGs discussed about the patient assessment to determine risk stratification for VTE and most CPGs agree that tools have limitations and an individual risk assessment was necessary to focus on patient-specific characteristics,

incorporating surgery-specific risk in addition to medical factors. These recommendations were summarized into the risk of VTE and bleeding risk categories.

Some high-quality CPGs included recommendations about the involvement of the patient and family in the management of the prophylaxis of VTE and monitoring adverse effects during the use of the pharmacological prophylaxis. These recommendations were summarized in the category of patient involvement and monitoring adverse effects respectively.

Thus, analyzing the methodological quality and summarizing the recommendations were important steps to support the process of adopting new guidelines for pharmacological prophylaxis of VTE in adult hospitalized surgical and medical patients.
