Format

Send to

Choose Destination
Chest. 2016 Feb;149(2):315-352. doi: 10.1016/j.chest.2015.11.026. Epub 2016 Jan 7.

Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report.

Author information

1
McMaster University, Hamilton, ON.
2
McMaster University, Hamilton, ON; American University of Beirut, Beirut, Lebanon. Electronic address: ea32@aub.edu.lb.
3
CHEST, Glenview, IL.
4
VA New Jersey Health Care System, Newark, NJ.
5
Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcala, Madrid, Spain.
6
University of Geneva, Geneva, Switzerland.
7
Leiden University Medical Center, Leiden, Netherlands.
8
Virginia Commonwealth University, Falls Church, VA.
9
University of California, San Diego, CA.
10
The Ohio State University, Columbus, OH.
11
Intermountain Medical Center and the University of Utah, Murray, UT.
12
Harbor-UCLA Medical Center, Torrance, CA.
13
The University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON.
14
Uniformed Services University of the Health Sciences, Bethesda, MD.

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

PMID:
26867832
DOI:
10.1016/j.chest.2015.11.026
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center