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Antithrombotic Therapy for VTE Disease

Second Update of the CHEST Guideline and Expert Panel Report
Published:August 02, 2021DOI:https://doi.org/10.1016/j.chest.2021.07.055

      Background

      This is the 2nd update to the 9th edition of these guidelines. We provide recommendations on 17 PICO (Population, Intervention, Comparator, Outcome) questions, four of which have not been addressed previously.

      Methods

      We generate strong and weak recommendations based on high-, moderate-, and low-certainty evidence, using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology.

      Results

      The panel generated 29 guidance statements, 13 of which are graded as strong recommendations, covering aspects of antithrombotic management of VTE from initial management through secondary prevention and risk reduction of postthrombotic syndrome. Four new guidance statements have been added that did not appear in the 9th edition (2012) or 1st update (2016). Eight statements have been substantially modified from the 1st update.

      Conclusion

      New evidence has emerged since 2016 that further informs the standard of care for patients with VTE. Substantial uncertainty remains regarding important management questions, particularly in limited disease and special patient populations.

      Key Words

      Abbreviations:

      APS (antiphospholipid syndrome), AT9 (Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines), CAT (cancer-associated thrombosis), CDT (catheter-directed thrombolysis), COI (conflict of interest), CVT (cerebral vein thrombosis), DOAC (direct-acting oral anticoagulant), EtD (evidence-to-decision), GCS (graduated compression stockings), GOC (Guidelines Oversight Committee), GRADE (Grading of Recommendations, Assessment, Development, and Evaluation), IDDVT (isolated distal DVT), INR (international normalized ratio), ISSPE (isolated subsegmental pulmonary embolism), IVC (inferior vena cava), LMWH (low-molecular-weight heparin), PE (pulmonary embolism), PICO (Population, Intervention, Comparator, Outcome), PREPIC (Prévention du Risque d’Embolie Pulmonaire par Interruption Cave), PTS (postthrombotic syndrome), RCT (randomized controlled trial), SVT (superficial venous thrombosis), US (ultrasound), VKA (vitamin K antagonist)
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