The ACCP (American College of Chest Physicians) has issued its new antithrombotic guideline update for treatment of venous thromboembolism (VTE) (ACCP 2016). This is the 10th edition, updating the 9th edition that was published in 2012. Since the 9th edition the clinical trials of several novel oral anticoagulants (NOAC’s) have been completed and published and the new 10th addition acknowledges the place of these in the management of VTE.
According to the press release from the ACCP the key changes to recommendations in the 9th edition to the 10th edition include:
For VTE and no cancer, as long-term anticoagulant therapy, the new guideline suggests NOAC’s (dabigatran, rivaroxaban, apixaban, or edoxaban) over vitamin K antagonist (VKA) therapy and suggests VKA therapy over LMWH. However, for VTE and cancer it suggests LMWH over VKA or the NOAC’s.
Importantly, of 54 recommendations included in the total 30 statements, 20 were strong and none was based on high quality evidence. This highlights the need for further research.
The full guideline is available in CHEST (Kearon 2016).
ACCP (American College of Chest Physicians). CHEST issues new antithrombotic guideline update for treatment of VTE disease. Press release January 7, 2016
Kearon C, Akl EA, Ornelas J, et al. Antithrombotic Therapy for VTE Disease: CHEST Guideline. Chest 2016; January 2016