Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report - PubMed
Practice Guideline
. 2016 Feb;149(2):315-352.
doi: 10.1016/j.chest.2015.11.026. Epub 2016 Jan 7.
Elie A Akl 2 , Joseph Ornelas 3 , Allen Blaivas 4 , David Jimenez 5 , Henri Bounameaux 6 , Menno Huisman 7 , Christopher S King 8 , Timothy A Morris 9 , Namita Sood 10 , Scott M Stevens 11 , Janine R E Vintch 12 , Philip Wells 13 , Scott C Woller 11 , Lisa Moores 14
Affiliations
- PMID: 26867832
- DOI: 10.1016/j.chest.2015.11.026
Practice Guideline
Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report
Clive Kearon et al. Chest. 2016 Feb.
Erratum in
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[No authors listed] [No authors listed] Chest. 2016 Oct;150(4):988. doi: 10.1016/j.chest.2016.08.1442. Chest. 2016. PMID: 27719823 No abstract available.
Abstract
Background: We update recommendations on 12 topics that were in the 9th edition of these guidelines, and address 3 new topics.
Methods: We generate strong (Grade 1) and weak (Grade 2) recommendations based on high- (Grade A), moderate- (Grade B), and low- (Grade C) quality evidence.
Results: For VTE and no cancer, as long-term anticoagulant therapy, we suggest dabigatran (Grade 2B), rivaroxaban (Grade 2B), apixaban (Grade 2B), or edoxaban (Grade 2B) over vitamin K antagonist (VKA) therapy, and suggest VKA therapy over low-molecular-weight heparin (LMWH; Grade 2C). For VTE and cancer, we suggest LMWH over VKA (Grade 2B), dabigatran (Grade 2C), rivaroxaban (Grade 2C), apixaban (Grade 2C), or edoxaban (Grade 2C). We have not changed recommendations for who should stop anticoagulation at 3 months or receive extended therapy. For VTE treated with anticoagulants, we recommend against an inferior vena cava filter (Grade 1B). For DVT, we suggest not using compression stockings routinely to prevent PTS (Grade 2B). For subsegmental pulmonary embolism and no proximal DVT, we suggest clinical surveillance over anticoagulation with a low risk of recurrent VTE (Grade 2C), and anticoagulation over clinical surveillance with a high risk (Grade 2C). We suggest thrombolytic therapy for pulmonary embolism with hypotension (Grade 2B), and systemic therapy over catheter-directed thrombolysis (Grade 2C). For recurrent VTE on a non-LMWH anticoagulant, we suggest LMWH (Grade 2C); for recurrent VTE on LMWH, we suggest increasing the LMWH dose (Grade 2C).
Conclusions: 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.
Keywords: GRADE approach; antithrombotic therapy; evidence-based medicine; venous thromboembolism.
Copyright © 2016 American College of Chest Physicians. All rights reserved.
Comment in
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Update of Antithrombotic Guidelines: Medical Professionalism and the Funnel of Knowledge.
Heffner JE. Heffner JE. Chest. 2016 Feb;149(2):293-294. doi: 10.1016/j.chest.2015.12.005. Epub 2016 Jan 8. Chest. 2016. PMID: 26867824 No abstract available.
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Evidence-Based Guideline: CHEST made 20 strong recommendations about antithrombotic therapy for VTE.
White RH. White RH. Ann Intern Med. 2016 May 17;164(10):JC52. doi: 10.7326/ACPJC-2016-164-10-052. Ann Intern Med. 2016. PMID: 27182918 No abstract available.
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In Reply: Submassive pulmonary embolism.
Ataya A, Cope J, Shahmohammadi A, Alnuaimat H. Ataya A, et al. Cleve Clin J Med. 2017 Feb;84(2):94-95. doi: 10.3949/ccjm.84c.02004. Cleve Clin J Med. 2017. PMID: 28198695 No abstract available.
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Safani M, Tobias S, Robinson M, Hwang J, Thomas GS. Safani M, et al. Chest. 2017 May;151(5):1187-1188. doi: 10.1016/j.chest.2016.12.016. Chest. 2017. PMID: 28483119 No abstract available.
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