The American College of Chest Physicians has released the latest evidence-based guidelines, with updated recommendations, for appropriate treatment of patients with venous thromboembolism (VTE).

The 10th edition of the Antithrombotic Therapy for VTE Disease: CHEST Guideline contains some strong recommendations as well as weaker suggestions for VTE treatment options, gaps in knowledge, and topics for future research. Recommendations range from strong (Grade 1), and weak (Grade 2) and are based on high (Grade A), moderate (Grade B), and low (Grade C) quality service.

RELATED: Many High-Risk Patients Still Not Receiving VTE Prophylaxis

Major recommendation changes from the 9th edition include:

  • Non-vitamin K antagonist oral anticoagulants (NOACs) are suggested over warfarin for initial and long-term treatment of VTE in patients without cancer. 
  • Compression stockings should not be routinely used to prevent post-thrombotic syndrome in patients with acute DVT. 
  • Suggestions as to which patients diagnosed with isolated subsegmental pulmonary embolism (SSPC) should, and should not, receive anticoagulant therapy.

Specifically, the new guidelines recommend long-term therapy with dabigatran (Grade 2B), rivaroxaban (Grade 2B), apixaban (Grade 2B) or edoxaban (Grade 2B) over vitamin K antagonist (VKA) therapy, and suggest VKA therapy over LMWH (Grade 2C) in patients with VTE and no cancer. For patients with VTE and cancer, the new guidelines recommend low-molecular weight heparin (LMWH) over VKA (Grade 2B), dabigatran (Grade 2C), rivaroxaban (Grade 2C), apixaban (Grade 2C) or edoxaban (Grade 2C).

Recommendations regarding who should stop anticoagulation at 3 months or receive extended therapy have not changed. Of the 54 recommendations mentioned in the 30 statements, 20 were considered strong and none were based on high quality evidence. Experts emphasize the need for further research. 

The updated guidelines have been endorsed by American Association for Clinical Chemistry, American College of Clinical Pharmacy, International Society for Thrombosis and Haemostasis, and American Society of Health-System Pharmacists.

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