New Guidelines on Antithrombotic Therapy for VTE Disease Issued by American College of Chest Physicians

August 3, 2021—The American College of Chest Physicians (CHEST) recently released new clinical guidelines for venous thromboembolism (VTE) management. “Antithrombotic Therapy for VTE Disease: Second Update of the CHEST Guideline and Expert Panel” provides 29 recommendations on 17 Patients, Interventions, Comparators, Outcomes (PICO) questions, four of which have not been addressed previously. The guidelines by Scott M. Stevens, MD, et al are available online in the CHEST journal.

According to the CHEST press release, this guideline is the first to address this topic and will be regularly updated as new evidence emerges according to the Living Guidelines Model of CHEST.

The guidance statements are intended primarily for clinicians who manage patients with VTE but may inform researchers in selecting questions for future studies. Patients and policymakers may also be informed by the guideline content, noted the CHEST announcement.

As noted in the announcement, this is the second update to the ninth edition of these guidelines. The last full edition of the guideline, “Antithrombotic Therapy and Prevention of Thrombosis 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines,” was published in 2012 by Clive Kearon, MD, et al in CHEST (2012;141(suppl):E419S-E496S). The ninth edition of the guidelines were last updated in 2016 by Dr. Kearon et al in CHEST (2016;149:315-352).

In the updated recommendations, the panel generated 29 guidance statements, 13 of which were graded as strong recommendations. These include:

• In patients with acute isolated distal deep vein thrombosis (DVT) of the leg who are managed with anticoagulation, they recommend using the same anticoagulant regimen as for patients with acute proximal DVT.
• In patients with cerebral venous sinus thrombosis, they recommend anticoagulation therapy for at least the treatment phase (first 3 months) over no anticoagulant therapy.
• In patients with acute DVT of the leg, they recommend against the use of an inferior vena cava filter in addition to anticoagulants.
• In patients with thrombosis and antiphospholipid syndrome being treated with anticoagulant therapy, they suggest adjusted-dose vitamin K antagonists over direct oral anticoagulant therapy.

“These guidelines help to clarify for providers the intricacies of managing patients with VTE,” commented expert panel member, Scott C. Woller, MD, in the press release. “Serving as a comprehensive reference for any stage, the recommendations cover aspects from initial management through secondary prevention and risk reduction of postthrombotic syndrome.”

Additionally, the announcement noted that the order of presentation of the PICOs and guidance statements in the document follows the chronology of VTE management: whether to treat, interventional and adjunctive treatments, initiation phase, treatment phase, extended phase, and complications of VTE.