ACCP GUIDELINES DVT PROPHYLAXIS 2012 PDF

In regard to new oral anticoagulants, guideline authors recognize the recent clinical trials of apixaban and rivaroxaban, both direct factor Xa inhibitors, and dabigatran etexilate, a direct thrombin inhibitor, and offer recommendations for the new agents for select clinical conditions, including atrial fibrillation and orthopedic surgery. Innovations in Antithrombotic Guidelines The Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines include innovations that have significantly impacted the more than recommendations for the prevention, diagnosis, and treatment of thrombosis. Two key advances are the more explicit and quantitative consideration of patient values and preferences and restriction of outcomes to only those deemed to be important for the patient. The latter innovation results in different interpretation of the body of evidence in thrombosis prevention that has previously focused on the detection of asymptomatic thrombosis by surveillance methods.

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Chest ; Anticoagulants should stop after 3 months of therapy in patients with an acute, proximal deep venous thrombosis DVT provoked by surgery rather than shorter or longer treatment courses Grade 1B. Anticoagulants should also be stopped after 3 months in patients with a proximal DVT or pulmonary embolism PE provoked by a nonsurgical transient risk factor over shorter or longer courses Grade 1B for high bleeding risk patients, Grade 2B for low or moderate bleeding risk patients.

Anticoagulation should be given for 3 months in patients with a first unprovoked VTE and a high risk of bleeding Grade 1B , but should be extended without a scheduled stop date in patients with a low or moderate risk of bleeding Grade 2B. For patients with acute VTE who are treated with anticoagulation, the guideline recommends against the use of an inferior vena cava filter Grade 1B. For patients with an unprovoked proximal DVT or PE who are stopping anticoagulant therapy, the guideline suggests the use of aspirin over no aspirin to prevent recurrent VTE if there are no contraindications to aspirin therapy Grade 2B.

For patients with acute DVT, the guideline recommends against the use of compression stockings routinely to prevent the post-thrombotic syndrome Grade 2B. The guideline recommends the use of anticoagulation over surveillance when the risk of VTE recurrence is high Grade 2C.

For patients with an acute PE and hypotension massive PE , the guideline recommends the use of thrombolytic therapy Grade 2B , preferring systemic therapy over catheter-directed thrombolytic therapy Grade 2C. Share via:.

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New guidelines cover VTE prophylaxis, diagnosis, anticoagulation, and HIT

Chest ; Anticoagulants should stop after 3 months of therapy in patients with an acute, proximal deep venous thrombosis DVT provoked by surgery rather than shorter or longer treatment courses Grade 1B. Anticoagulants should also be stopped after 3 months in patients with a proximal DVT or pulmonary embolism PE provoked by a nonsurgical transient risk factor over shorter or longer courses Grade 1B for high bleeding risk patients, Grade 2B for low or moderate bleeding risk patients. Anticoagulation should be given for 3 months in patients with a first unprovoked VTE and a high risk of bleeding Grade 1B , but should be extended without a scheduled stop date in patients with a low or moderate risk of bleeding Grade 2B. For patients with acute VTE who are treated with anticoagulation, the guideline recommends against the use of an inferior vena cava filter Grade 1B.

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Updated ACCP Guideline for Antithrombotic Therapy for VTE Disease

Although it is well-known that anticoagulation therapy is effective in the prevention and treatment of VTE events, these agents are some of the highest-risk medications a hospitalist will prescribe given the danger of major bleeding. With the recent approval of several newer anticoagulants, it is important for the practicing hospitalist to be comfortable initiating, maintaining, and stopping these agents in a wide variety of patient populations. Image Credit: Shuttershock. This 10th-edition guideline update is referred to as AT Now, the direct oral anticoagulants DOACs dabigatran, rivaroxaban, apixaban, or edoxaban are recommended over warfarin.

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New Guidelines Suggest DVT Prophylaxis not Appropriate for All Patients

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