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… In general: “Yes”. Many people who take blood thinners are able to safely dive. However, there are a few things to consider for the individual on blood thinners who wants to go scuba diving: Read the rest of this entry »
Stephan Moll, MD writes… A plain language summary for patients and interested public about homocysteine and the MTHFR mutations and their relevance in respect to blood clots was published today in the journal Circulation (link here).
Reference: Moll S, Varga EA. Homocysteine and MTHFR Mutations. Circulation. 2015;132:e6-e.
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… A clinical research study is being conducted in the U.S. for the treatment of chronic deep vein thrombosis (DVT) with post-thrombotic syndrome (PTS) and is open for enrollment. It is referred to as ACCESS-PTS. Read the rest of this entry »
Stephan Moll, MD writes: A drug in development (Idarucizumab) that reverses the blood thinner Pradaxa® (Dabigatran) is on a very promising path to get FDA approval in the next few months and be available for clinical use by the end of 2015.
Read the rest of this entry »
Stephan Moll, MD writes… A publication today in the journal Vascular Medicine discusses – for patients and family members – (a) in which patient with blood clots (DVT, PE) to consider testing for a clotting disorder, (b) what tests might be appropriate to do, (c) how the test results influence management with blood thinners, (d) what birth control methods are safe in women with history of blood clots or a clotting disorder, and (e) in which family members to consider thrombophilia testing (link here for the article).
Last updated: April 1st, 2015
Stephan Moll, MD writes…. Today (Jan 8th, 2015) the FDA approved yet another new oral blood thinner, Savaysa (edoxaban), for the treatment of DVT and PE. The drug was also FDA approved today for stroke prevention in patients with irregular heart beat (atrial fibrillation). The FDA press release here (link). Read the rest of this entry »
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 (on Dec 8th, 2014)… A publication this week in the New England Journal of Medicine reports on a drug in development that protects patients from blood clots (DVT), without increasing the risk of bleeding. Too good to be true? Possibly, but may be not. Additional studies will have to tell. Read the rest of this entry »