Photo courtesy of NIGMS
The American College of Chest Physicians has released a new edition of guidelines for the treatment of patients with venous thromboembolism (VTE).
This 10th edition of the guidelines, published in CHEST, includes 54 recommendations. However, only 20 of these recommendations were deemed “strong,” and none were based on high-quality evidence.
“The guideline presents stronger recommendations and weaker suggestions for treatment based on the best available evidence and identifies gaps in our knowledge and areas for future research,” said lead author Clive Kearon, MD, PhD, of McMaster University in Hamilton, Ontario, Canada.
One of the key recommendations in the guidelines is a preference for novel oral anticoagulants (NOACs) over vitamin K antagonist (VKA) therapy for initial and long-term treatment of VTE in patients without cancer.
The guideline authors say that, since the publication of the 9th edition, studies have shown that NOACs are as effective as VKA therapy, and NOACs confer a reduced risk of bleeding and increased convenience for patients and healthcare providers.
As long-term anticoagulant therapy for patients without cancer, the guideline authors suggest dabigatran, rivaroxaban, apixaban, or edoxaban over VKA therapy. But they suggest VKA therapy over low-molecular-weight heparin.
For patients with VTE and cancer, the guideline authors suggest low-molecular-weight heparin over VKA, dabigatran, rivaroxaban, apixaban, or edoxaban.
The guidelines advise against an inferior vena cava filter for patients with VTE who are receiving anticoagulant treatment.
Another change to guideline recommendations from the 9th edition to the 10th edition concerns the routine use of compression stockings. Based on recent evidence, the 10th edition advises against routinely using compression stockings to prevent post-thrombotic syndrome in patients with acute deep vein thrombosis (DVT).
The 10th edition also suggests which patients diagnosed with isolated subsegmental pulmonary embolism (PE) should, and should not, receive anticoagulant therapy.
For subsegmental PE and no proximal DVT, the guidelines suggest clinical surveillance over anticoagulation if patients have a low risk of recurrent VTE and anticoagulation over clinical surveillance if patients have a high risk of recurrence.
The guidelines suggest thrombolytic therapy for patients with PE and hypotension and systemic therapy over catheter-directed thrombolysis.
To date, the updated guidelines have been endorsed by the American Association for Clinical Chemistry, American College of Clinical Pharmacy, International Society for Thrombosis and Haemostasis, and American Society of Health-System Pharmacists.
