The American Society of Hematology (ASH) has issued clinical practice guidelines on the management of venous thromboembolism (VTE). 

The guidelines were developed by over 100 experts, including hematologists, patient representatives, and other specialists. The first 6 chapters have been published in the journal Blood Advances; 4 additional chapters are in development. The 149 total panel recommendations address the following major conditions and topics:

  • Prophylaxis for hospitalized and non-hospitalized medical patients
  • Diagnosis of VTE
  • Optimal management of anticoagulation therapy
  • Heparin-induced thrombocytopenia
  • VTE in the context of pregnancy
  • Treatment of pediatric VTE
  • Treatment of deep-vein thrombosis and pulmonary embolism (anticipated in 2019)
  • VTE in patients with cancer (anticipated in 2019)
  • Thrombophilia (anticipated in 2019)
  • Prevention of VTE in surgical patients (anticipated in 2019)

With regard to initial anticoagulant dose selection, the panel suggests that for obese patients receiving low-molecular-weight heparin (LMWH) for acute VTE, initial dose selection should be selected based on actual body weight rather than on a fixed maximum daily dose (Conditional recommendation). As for drug-interaction management, the experts suggest patients taking concomitant P-gp inhibitors or inducers, or strong CYP450 inhibitors or inducers, should receive an alternative anticoagulant (vitamin K antagonist or LMWH) rather than direct oral anticoagulants (Conditional recommendation). More recommendations on optimal anticoagulation therapy management can be found here.

“The 2018 ASH guidelines took the latest evidence into account to make recommendations that in some instances will reinforce existing best practices and in other instances will change practice,” said Adam Cuker, MD, MS, Chair, ASH VTE Guidelines Coordination Panel and HIT Panel and Clinical Director of the Penn Blood Disorders Center and Director of the Penn Comprehensive and Hemophilia Thrombosis Program, University of Pennsylvania in Philadelphia. 

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