CHEST Guidelines-Antithrombotic-Therapy-for-VTE-Disease_2021

Antithrombotic-Therapy-for-VTE-Disease_2021_chest

Pdf Summary

The second update of the CHEST Guideline and Expert Panel Report on Antithrombotic Therapy for VTE Disease provides comprehensive guidance on the management of venous thromboembolism (VTE). This update addresses 17 PICO (Population, Intervention, Comparator, Outcome) questions, leading to 29 guidance statements, of which 13 are strong recommendations based on the GRADE (Grading of Recommendations, Development, and Evaluation) methodology. <br /><br />The guidelines cover a range of issues in VTE management, from initial treatment to secondary prevention and the reduction of post-thrombotic syndrome risk. Key recommendations include: <br /><br />1. For acute isolated distal deep vein thrombosis (DVT) without severe symptoms, a preference for serial imaging over anticoagulation. For those with severe symptoms, anticoagulation is preferred.<br />2. In subsegmental pulmonary embolism (PE) with no proximal DVT, clinical surveillance is suggested if the risk for recurrent VTE is low, whereas anticoagulation is preferred if the risk is higher.<br />3. In incidentally found asymptomatic PE, treatment should match symptomatic cases.<br />4. Cerebral vein thrombosis should be treated with anticoagulation for at least the first three months.<br />5. Systemic thrombolytic therapy is recommended for PE with hypotension unless there's a high bleeding risk.<br />6. Systematic administration of thrombolytics in acute PE not associated with hypotension is generally not recommended.<br />7. Inferior vena cava (IVC) filters are discouraged alongside anticoagulation for acute DVT but are recommended if there are contraindications to anticoagulation.<br />8. Direct oral anticoagulants (DOACs) are favored over Vitamin K antagonists for the initial treatment phase of acute VTE.<br /><br />The guidelines also address treatment duration, suggesting three months of anticoagulation for unprovoked VTE, with some patients warranting extended anticoagulation based on risk factors. Reduced-dose DOACs are recommended for extended therapy to reduce bleeding risks compared to full-dose. Aspirin serves as a secondary prevention measure if anticoagulation is stopped.<br /><br />Finally, the guidelines suggest against the routine use of compression stockings after DVT for post-thrombotic syndrome prevention, reflecting emerging evidence questioning their efficacy.

Keywords

Antithrombotic Therapy

Venous Thromboembolism

VTE Management

CHEST Guideline

PICO Questions

GRADE Methodology

Direct Oral Anticoagulants

Thrombolytic Therapy

Inferior Vena Cava Filters

Post-thrombotic Syndrome