ASH 2021 guideline on management of venous thromboembolism
Delhi: The American Society of Hematology (ASH) in association with other local hematology societies has developed an updated guideline for the management of venous thromboembolism. The purpose of the study, published in the journal Blood Advances was to provide evidence-based guidelines about managing VTE for Latin American patients, clinicians, and decision-makers.The authors used the...
Delhi: The American Society of Hematology (ASH) in association with other local hematology societies has developed an updated guideline for the management of venous thromboembolism.
The purpose of the study, published in the journal Blood Advances was to provide evidence-based guidelines about managing VTE for Latin American patients, clinicians, and decision-makers.
The authors used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE)-ADOLOPMENT method to adapt recommendations from 2 American Society of Hematology (ASH) VTE guidelines (Treatment of VTE and Anticoagulation Therapy).
The guideline panel comprised medical professionals from 10 countries in Latin America. The panel agreed on 17 recommendations. Compared with the original guideline, 4 recommendations changed direction, and 1 changed strength.
Key recommendations include:
- In patients with deep vein thrombosis, DVT, the ASH Latin American Guideline Panel suggests home treatment over hospital treatment.
- In patients with PE and a low risk of complications, the ASH Latin American Guideline Panel suggests using either home treatment or hospital treatment.
- In patients with DVT or PE, the ASH Latin American Guideline Panel suggests using DOACs over VKAs.
- In patients with extensive proximal DVT, the ASH Latin American Guideline Panel suggests against thrombolysis in addition to anticoagulation.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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
- 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.
- 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.
- 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.
- In patients with DVT or PE during treatment with VKAs, the ASH Latin American Guideline Panel suggests using LMWH over DOACs.
- 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.
- 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.
- 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.
This guideline adolopment project highlighted the importance of contextualization of recommendations suggested by the changes to the original recommendations. The panel also identified 2 implementation priorities for the region: expanding the availability of home treatment and increasing the availability of direct oral anticoagulants (DOACs).
The guideline panel made a conditional recommendation in favor of home treatment for individuals with deep venous thrombosis and a conditional recommendation for either home or hospital treatment for individuals with pulmonary embolism. In addition, a conditional recommendation was made in favor of DOACs over vitamin K antagonists for several populations.
Reference:
"ASH, ABHH, ACHO, Grupo CAHT, Grupo CLAHT, SAH, SBHH, SHU, SOCHIHEM, SOMETH, Sociedad Panameña de Hematología, SPH, and SVH 2021 guidelines for management of venous thromboembolism in Latin America," is published in the journal Blood Advances.
DOI: https://ashpublications.org/bloodadvances/article/5/15/3032/476514/ASH-ABHH-ACHO-Grupo-CAHT-Grupo-CLAHT-SAH-SBHH-SHU
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