The American College of Chest Physicians has placed Antithrombotic Therapy for VTE Disease: Second Update of the CHEST Guideline and Expert Panel Report behind a paywall! [PubMed Abstract]. Chest. 2021 Aug 2;S0012-3692(21)01506-3.
So instead, here is the link to PRIMARY CARE-American College of Chest Physicians Guideline on Antithrombotic Therapy for VTE Disease from ObG Project accessed 11-26-2021.
All that follows is from the ObG Project article above. Please review the complete article by clicking on the article.
The decision whether to prescribe anticoagulation (AC) for deep vein thrombosis (DVT) or pulmonary embolism (PE), and for what duration, is a highly individualized one that must take into account several clinical variables as well as patient preferences. Recommendations for AC are tailored based on a patient’s bleeding risk profile, characteristics of DVT (proximal vs. distal) and the clinical context in which VTE has occurred (provoked by a major transient risk factor present within 3 months of VTE, provoked by minor transient risk factor within 2 months of diagnosis, provoked by a persistent risk factor, or unprovoked). The American College of Chest Physicians offers a comprehensive evidence-based guideline on how and when to treat VTE with anticoagulation. The new guideline statement also provides guidance based on phase of management
- Treatment phase for acute VTE should last 3 months
- Extended-phase anticoagulation treatment is not needed if risk factors are transient
- Aspirin is not a reasonable alternative to therapy however is reasonable for prevention of recurrent VTE after completion of therapy
- Patients selected to receive extended phase therapy should be offered a reduced dose over full dose of apixaban or rivaroxaban over aspirin or no therapy
- Consider thrombolytic therapy in patients with a PE that are hemodynamically unstable
- Previous scenarios where anticoagulation was not recommended, such as superficial DVTs, may warrant a shorter duration of anticoagulation therapy for 45 days based on risk factors for progression of thrombus
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