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Updated VTE Guidelines

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These are from the CHEST guidelines, from the American College of Chest Physicians. These 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.

They updated recommendations on 12 topics and and address 3 new topics.

Per the updated guidelines, they state,

“Of 54 recommendations included in the 30 statements, 20 were strong and none was based on high-quality evidence, highlighting the need for further research.”

Key changes to recommendations include:

  1. Non-vitamin K antagonist oral anticoagulants (NOACs) are suggested over warfarin for initial and long-term treatment of VTE in patients without cancer. Since publication of the 9th edition, new studies show that NOACs are as effective as VKA therapy with reduced risk of bleeding and increased convenience for patients and health-care providers.
  2. Routine use of compression stockings is out to prevent postthrombotic syndrome in acute DVT. Based on recent evidence, the 10th edition suggests not to routinely use compression stockings to prevent postthrombotic syndrome in patients with acute DVT. Postthrombotic syndrome is a chronic condition of the leg with swelling, pain, skin discoloration, and even ulcers. In the 9th edition, compression stockings were routinely suggested as a preventive measure in these patients.
  3. New isolated subsegmental pulmonary embolism treatment recommendations. The 10th edition suggests which patients diagnosed with isolated subsegmental pulmonary embolism (SSPE) should, and should not, receive anticoagulant therapy.

You can check out the full report here.