Patient Education Blog

New Guideline for treatment of DVT and PE – ACCP 2016

| Comments Off on New Guideline for treatment of DVT and PE – ACCP 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.

30 Recommendations

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.

Key Recommendations

  • 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.

Personal comment

This is a solid guideline and good publication.

 

REFERENCE

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

Homocysteine and MTHFR Mutations – A Summary for Patients

| Comments Off on Homocysteine and MTHFR Mutations – A Summary for Patients

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.

 

 

Patient Volunteers Needed for Guideline Development

| Comments Off on Patient Volunteers Needed for Guideline Development

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

Clotting Disorders (Thrombophilia): Who Should Be Tested? What To Test?

| Comments Off on Clotting Disorders (Thrombophilia): Who Should Be Tested? What To Test?

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).

 

Disclosures:  None

Last updated: April 1st, 2015

 

 

Another Oral Blood Thinner FDA-Approved for DVT and PE – Savaysa

| Comments Off on Another Oral Blood Thinner FDA-Approved for DVT and PE – Savaysa

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 »

Two Things Physicians Should Avoid

| Comments Off on Two Things Physicians Should Avoid

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 »

Fascinating New Drug that Prevents Blood Clots Without Increasing Bleeding Risk

| Comments Off on Fascinating New Drug that Prevents Blood Clots Without Increasing Bleeding Risk

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 »