Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.
- Kearon C Department of Medicine and Clinical Epidemiology and Biostatistics, Michael De Groote School of Medicine, McMaster University, Hamilton, ON, Canada.
- Akl EA Department of Medicine, Family Medicine, and Social and Preventive Medicine, State University of New York at Buffalo, Buffalo, NY. Electronic address: elieakl@buffalo.edu.
- Comerota AJ Department of Surgery, Jobst Vascular Center, Toledo, OH.
- Prandoni P Department of Cardiothoracic and Vascular Sciences, University of Padua, Padua, Italy.
- Bounameaux H Department of Medical Specialties, University Hospitals of Geneva, Geneva, Switzerland.
- Goldhaber SZ Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
- Nelson ME Department of Medicine, Shawnee Mission Medical Center, Shawnee Mission, KS.
- Wells PS Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
- Gould MK Department of Medicine and Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA.
- Dentali F Department of Medicine, University of Insubria, Varese, Italy.
- Crowther M Department of Medicine, Michael De Groote School of Medicine, McMaster University, Hamilton, ON, Canada.
- Kahn SR Department of Medicine and Clinical Epidemiology and Biostatistics, McGill University, Montreal, QC, Canada.
- 2012-02-09
Published in:
- Chest. - 2012
Administration, Oral
Anticoagulants
Diagnostic Imaging
Drug Administration Schedule
Evidence-Based Medicine
Fibrinolytic Agents
Fondaparinux
Hemorrhage
Heparin, Low-Molecular-Weight
Humans
Infusions, Intravenous
International Normalized Ratio
Long-Term Care
Polysaccharides
Pulmonary Embolism
Risk Factors
Societies, Medical
United States
Venous Thrombosis
Vitamin K
English
BACKGROUND
This article addresses the treatment of VTE disease.
METHODS
We generated strong (Grade 1) and weak (Grade 2) recommendations based on high-quality (Grade A), moderate-quality (Grade B), and low-quality (Grade C) evidence.
RESULTS
For acute DVT or pulmonary embolism (PE), we recommend initial parenteral anticoagulant therapy (Grade 1B) or anticoagulation with rivaroxaban. We suggest low-molecular-weight heparin (LMWH) or fondaparinux over IV unfractionated heparin (Grade 2C) or subcutaneous unfractionated heparin (Grade 2B). We suggest thrombolytic therapy for PE with hypotension (Grade 2C). For proximal DVT or PE, we recommend treatment of 3 months over shorter periods (Grade 1B). For a first proximal DVT or PE that is provoked by surgery or by a nonsurgical transient risk factor, we recommend 3 months of therapy (Grade 1B; Grade 2B if provoked by a nonsurgical risk factor and low or moderate bleeding risk); that is unprovoked, we suggest extended therapy if bleeding risk is low or moderate (Grade 2B) and recommend 3 months of therapy if bleeding risk is high (Grade 1B); and that is associated with active cancer, we recommend extended therapy (Grade 1B; Grade 2B if high bleeding risk) and suggest LMWH over vitamin K antagonists (Grade 2B). We suggest vitamin K antagonists or LMWH over dabigatran or rivaroxaban (Grade 2B). We suggest compression stockings to prevent the postthrombotic syndrome (Grade 2B). For extensive superficial vein thrombosis, we suggest prophylactic-dose fondaparinux or LMWH over no anticoagulation (Grade 2B), and suggest fondaparinux over LMWH (Grade 2C).
CONCLUSION
Strong recommendations apply to most patients, whereas weak recommendations are sensitive to differences among patients, including their preferences.
This article addresses the treatment of VTE disease.
METHODS
We generated strong (Grade 1) and weak (Grade 2) recommendations based on high-quality (Grade A), moderate-quality (Grade B), and low-quality (Grade C) evidence.
RESULTS
For acute DVT or pulmonary embolism (PE), we recommend initial parenteral anticoagulant therapy (Grade 1B) or anticoagulation with rivaroxaban. We suggest low-molecular-weight heparin (LMWH) or fondaparinux over IV unfractionated heparin (Grade 2C) or subcutaneous unfractionated heparin (Grade 2B). We suggest thrombolytic therapy for PE with hypotension (Grade 2C). For proximal DVT or PE, we recommend treatment of 3 months over shorter periods (Grade 1B). For a first proximal DVT or PE that is provoked by surgery or by a nonsurgical transient risk factor, we recommend 3 months of therapy (Grade 1B; Grade 2B if provoked by a nonsurgical risk factor and low or moderate bleeding risk); that is unprovoked, we suggest extended therapy if bleeding risk is low or moderate (Grade 2B) and recommend 3 months of therapy if bleeding risk is high (Grade 1B); and that is associated with active cancer, we recommend extended therapy (Grade 1B; Grade 2B if high bleeding risk) and suggest LMWH over vitamin K antagonists (Grade 2B). We suggest vitamin K antagonists or LMWH over dabigatran or rivaroxaban (Grade 2B). We suggest compression stockings to prevent the postthrombotic syndrome (Grade 2B). For extensive superficial vein thrombosis, we suggest prophylactic-dose fondaparinux or LMWH over no anticoagulation (Grade 2B), and suggest fondaparinux over LMWH (Grade 2C).
CONCLUSION
Strong recommendations apply to most patients, whereas weak recommendations are sensitive to differences among patients, including their preferences.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1378/chest.11-2301
- PMID 22315268
- Persistent URL
- https://folia.unifr.ch/global/documents/240369
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