ASH 2021 guideline on management of venous thromboembolism

Key recommendations include:

1. In patients with deep vein thrombosis, DVT, the ASH Latin American Guideline Panel suggests home treatment over hospital treatment.
2. In patients with PE and a low risk of complications, the ASH Latin American Guideline Panel suggests using either home treatment or hospital treatment.
3. In patients with DVT or PE, the ASH Latin American Guideline Panel suggests using DOACs over VKAs.
4. In patients with extensive proximal DVT, the ASH Latin American Guideline Panel suggests against thrombolysis in addition to anticoagulation.
5. In patients with PE and ultrasonography or biomarkers compatible with RVD (submassive PE), the ASH Latin American Guideline Panel suggests against the use of thrombolysis in addition to anticoagulation.
6. In patients with DVT and a high risk of PTS, the ASH Latin American Guideline Panel suggests against using compression stockings in addition to anticoagulation.
7. In patients with unprovoked DVT or PE, the Latin American Guideline Panel suggests against use of D-dimer or prognostic scores to guide the duration of anticoagulation. Rather, the majority of individuals should be managed according to Recommendation 8.
8. In patients with an unprovoked DVT or PE, the ASH Latin American Guideline Panel suggests maintaining indefinite anticoagulation over discontinuing it after a period of 3 to 6 months.
9. In patients with a recurrent unprovoked DVT or PE, the ASH Latin American Guideline Panel recommends maintaining indefinite anticoagulation over discontinuing it after a period of 3 to 6 months.
10. In patients with a provoked DVT or PE related to a chronic risk factor (eg, chronic immobility), the ASH Latin American Guideline Panel recommends maintaining indefinite anticoagulation over discontinuing it after a period of 3 to 6 months
11. In patients with recurrent provoked DVT or PE and high risk of recurrence, the ASH Latin American Guideline Panel suggests maintaining indefinite anticoagulation over discontinuing it after a period of 3 to 6 months.
12. In patients in whom an indefinite duration of antithrombotic therapy is preferred after completion of an initial defined duration course of therapy (3 to 6 months), the ASH Latin American Guideline Panel suggests anticoagulation over aspirin.
13. In patients in whom an indefinite duration of DOAC use is preferred after completion of an initial defined duration course of therapy (3 to 6 months), the ASH Latin American Guideline Panel suggests using the standard dose of DOACs over a lower dose of DOACs.
14. In patients with DVT or PE during treatment with VKAs, the ASH Latin American Guideline Panel suggests using LMWH over DOACs.
15. In patients who use aspirin for primary cardiovascular prevention and initiate anticoagulation for a DVT or PE, the ASH Latin American Guideline Panel suggests against maintaining aspirin.
16. In patients receiving treatment for VTE who survive an episode of anticoagulation therapy-related major bleeding, the ASH Latin American Guideline Panel suggests resumption of oral anticoagulation therapy over discontinuation.
17. In patients with VKA-related life-threatening bleeding during treatment of VTE, the ASH Latin American Guideline Panel suggests using either 4-factor PCCs or FFP according to local availability and clinical circumstances.