Archive for the ‘Guidelines’ Category
Stephan Moll, MD writes… A new consensus guidance for health care professionals on management of DVT and PE – link here – was published today, Jan 18th, 2016, in the Journal of Thrombosis and Thrombolysis. The publication contains 13 chapters on various aspects of DVT and PE (acute treatment, decisions on length of blood thinner treatment, thrombophilia work-up, management at times of surgery, etc.). It incorporates both evidence-based data and consensus opinion of the 52 international experts who wrote these chapters. It is aimed at any type of health care professional who is involved in the management of DVT and PE – emergency room physicians, hospitalists, internists, cardiologists, hematologists, pharmacists and others.
Last updated: Jan 18th, 2016
The ACCP Chest Guidelines have been the main guide over the last more than 2 decades for evidence-based recommendations on best management of blood thinners for various indications, including DVT and PE. The 10th edition of the chapter on DVT and PE management was published in Jan 2016 [reference]. Unfortunately, the guideline is not available for non-subscribers.
This 38 page document focusses on the best management of DVT and PE. It provides 30 individual recommendations (page 7-19) and a discussion of the evidence behind the guidance. It uses the terms “suggest” and “recommend” for its guidance, depending on the strength of published evidence.
- Choice of blood thinner:
In patients with DVT of the leg or PE (and no cancer) the suggestion is to use one of the newer oral blood thinners (Eliquis, Pradaxa, Savaysa or Xarelto) rather than warfarin (Coumadin, Jantoven) therapy!
- Cancer patients with DVT or PE:
In cancer patients with DVT of the leg or PE an injectable blood thinner called “low molecular weight heparin” (Lovenox = enoxaparin; Fragmin = dalteparin; Innohep = tinzaparin) is suggested rather than an oral drug.
- How long to treat with blood thinners?
- DVT (in veins in the pelvis, thigh or behind the knee, termed “proximal DVT) or PE provoked by surgery: recommend 3 months of blood thinners.
- Proximal DVT or PE provoked by non-surgical transient risk factor (e.g. estrogens, pregnancy, leg injury, flight > 8 hrs): suggest 3 months of blood thinners.
- Unprovoked proximal DVT or PE: suggest long-term blood thinners.
- Distal DVT, i.e. below the knee
- if not severely symptomatic : suggest no blood thinners, but follow-up Doppler ultrasound imaging study
- if severely symptomatic: suggest 3 months of blood thinners.
- Role of aspirin:
In patients with unprovoked proximal DVT or PE who stop blood thinners, aspirin is suggested.
This is a solid guideline and good publication.
Kearon C et al. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest. 2016; 149(2):315-352
Conflict of interest: None
Last updated: Oct 27th, 2016
Stephan Moll, MD writes… The American Society of Hematology (ASH) is embarking on a program to develop clinically useful guidelines on the best management of patients with deep vein thrombosis or pulmonary embolism. ASH appropriately desires input from patients for the development of these guidelines. Any interested patient please see this letter from ASH explaining the goals of the project and what is needed.
Last updated: July 1st, 2015
Stephan Moll, MD writes (Dec 17, 2014)… The American Society of Hematology (ASH) published last week two things that physicians dealing with DVT, PE and blood thinners should avoid [ref 1]. Read the rest of this entry »
Stephan Moll, MD writes (on12/5/2014)… Prevention of DVT and PE in patients who are in the hospital is important. Hospitals are required to have mechanisms in place that guarantee that patients at risk for DVT and PE get appropriate prophylaxis [reference]. We have developed at the University of North Carolina (UNC) a guidance document (link here; UNC VTE prophylaxis guidance document) as a resource for our doctors to assist in making decisions on which patients to give what type of DVT and PE prophylaxis. We are making this document available for other doctors and hospitals, to use it as is or modify it as needed.
Recommendations provided in this document are a reflection of current guidelines, clinical evidence, and UNC institutional initiatives. Patients may look at this document to see what kind of DVT prophylaxis might be appropriate in certain situations, such as surgeries; and they should discuss appropriate prophylaxis with their physicians. However, this document is not intended to replace individual patient evaluation and management decisions.
Joint Commission VTE measures (link here)
Last updated: Dec 5th, 2014
Stephan Moll, MD writes… The American Society of Hematology (ASH) has identified 3 things that physicians dealing with DVT, PE and blood thinners (anticoagulants) should avoid – published this week in the journal Blood [ref 1]. Read the rest of this entry »
Beth Waldron, Clot Connect program director, writes…
If you’ve experienced deep vein thrombosis (DVT) or pulmonary embolism (PE), a recurrence of a blood clot in the future is a concern. Diagnosing a recurrent clot can be a challenge because it is sometimes difficult to tell if symptoms are the result of a new clot or the signs of chronic damage from the initial clot.
- Around 40% of patients with DVT develop long-term pain and swelling, known as post-thrombotic syndrome. Such pain and swelling can fluctuate, and be particularly pronounced after standing for prolonged periods of time or being overly active.
- Around 4% of patients with PE develop long-term shortness of breath, known as pulmonary hypertension.
How do healthcare professionals know when symptoms are the result of a past blood clot or due to a new clot? Read the rest of this entry »
Quick note: The respected ACCP (American College of Chest Physicians) guidelines on antithrombotic therapy were published today in its new 2012 edition, http://www.chestnet.org/accp, replacing the 2008 version.