CHEST Guidelines-Executive-Summary_2021

Executive-Summary_2021_chest

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The updated CHEST guideline on antithrombotic therapy for Venous Thromboembolism (VTE) disease presents a second update to previous versions and incorporates 29 guidance statements, including new recommendations not featured in prior editions. This update utilizes the GRADE methodology to ensure evidence-based recommendations, reflecting varying levels of certainty.<br /><br />Key additions include a strong focus on individualized patient care, emphasizing risk assessments and potentially variable approaches based on emerging evidence. The update notably addresses areas such as the management of cerebral vein thrombosis, isolated subsegmental pulmonary embolism, incidentally diagnosed asymptomatic acute pulmonary embolism, and the use of direct-acting oral anticoagulants (DOACs) versus vitamin K antagonists.<br /><br />Recommendations about thrombolytic therapy remain cautious, often suggesting avoidance except in specific acute contexts or patient risk profiles. New guidelines were crafted to assist decision-making on the prolongation of anticoagulation after the standard treatment phase, addressing whether patients should undertake extended-phase therapy, particularly when facing persistent or high-risk situations.<br /><br />A notable emphasis is placed on the use of DOACs for their safety, efficacy, and patient convenience, urging their preference over traditional therapies in many scenarios, while recognizing that specific conditions may warrant traditional approaches. The guideline advises against routine use of graduated compression stockings to prevent postthrombotic syndrome, citing limited benefits.<br /><br />The document also underscores the significance of incorporating patient preferences and risk assessments in therapy decisions, extending influence beyond clinicians to policymakers, patients, and researchers. These updates highlight a commitment to flexibility in therapeutic approaches while focusing on tailored patient management to optimize the balance of benefits and risks in treating VTE.

Keywords

CHEST guideline

antithrombotic therapy

Venous Thromboembolism

GRADE methodology

individualized patient care

direct-acting oral anticoagulants

thrombolytic therapy

extended-phase therapy

patient preferences

risk assessments