AHA Publishes Statement on Management of Severe Venous Thromboembolism

March 21, 2011—Michael R. Jaff, DO, et al have published an American Heart Association scientific statement online on the management of massive and submassive pulmonary embolism (PE), iliofemoral deep vein thrombosis (IF-DVT), and chronic thromboembolic pulmonary hypertension. The goal of the document is to provide practical advice to enable clinicians to optimize the management of patients with these severe manifestations of venous thromboembolism (VTE). The document is available online in Circulation (2011;123:1788–1830).

According to the statement, VTE is responsible for the hospitalization of more than 250,000 Americans annually and represents a significant risk for morbidity and mortality. Despite the publication of evidence-based clinical practice guidelines to aid in the management of VTE in its acute and chronic forms, the clinician is frequently confronted with manifestations of VTE for which data are sparse and optimal management is unclear. In particular, the optimal use of advanced therapies for acute VTE, including thrombolysis and catheter-based therapies, remains uncertain.

Although this document makes recommendations for management, optimal medical decisions must incorporate other factors, including patient wishes, quality of life, and life expectancy based on age and comorbidities. The appropriateness of these recommendations for a specific patient may vary depending on these factors and will be best judged by the bedside clinician, the authors advised.

In conclusion, the statement notes that standard management of uncomplicated PE and DVT has been well described in multiple publications. This scientific statement has evaluated the body of literature for management of massive and submassive acute PE, IF-DVT, and chronic thromboembolic pulmonary hypertension to make recommendations to guide clinicians.

The statement shares a significant limitation with other guideline documents in that the body of evidence to guide management for these forms of VTE is incomplete, and therefore, some recommendations must rely on lower levels of evidence or expert opinion.

The authors stated that there are several important clinical questions in the management of acute VTE that could be tested in randomized controlled trials. In addition to guiding practice, the authors hope that this document will help highlight these gaps and support the case for future clinical trials for these serious forms of VTE and their novel therapies. They strongly advised further clinical trials of the advanced therapies for VTE.