What’s New in the Patient Safety World
February 2016
Updated VTE Guidelines from ACCP
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:
- Non-vitamin K antagonist oral anticoagulants (NOACs) are suggested
over warfarin for initial and long-term treatment of VTE in patients
without cancer. Since publication of the 9th edition, new studies
show that NOACs are as effective as VKA therapy with reduced risk of
bleeding and increased convenience for patients and health-care providers.
- Routine use of compression stockings is out to prevent postthrombotic syndrome in acute DVT. Based on recent
evidence, the 10th edition suggests not to routinely use compression
stockings to prevent postthrombotic syndrome in
patients with acute DVT. Postthrombotic syndrome
is a chronic condition of the leg with swelling, pain, skin discoloration,
and even ulcers. In the 9th edition, compression stockings were
routinely suggested as a preventive measure in these patients.
- New isolated subsegmental pulmonary
embolism treatment recommendations. The 10th edition suggests which
patients diagnosed with isolated subsegmental
pulmonary embolism (SSPE) should, and should not, receive anticoagulant
therapy.
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).
References:
ACCP (American College of Chest Physicians). CHEST issues new antithrombotic guideline update for treatment of VTE disease. Press release January 7, 2016
https://www.chestnet.org/News/Press-Releases/2016/01/AT10-VTE
Kearon C, Akl EA, Ornelas J, et al. Antithrombotic Therapy for VTE Disease: CHEST Guideline. Chest 2016; January 2016
http://journal.publications.chestnet.org/data/Journals/CHEST/0/11026.pdf
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