Latest thrombosis guidelines issued by ACCP

8 February 2012

MedWire News: The American College of Chest Physicians has published the 9^th Edition of its “Antithrombotic Therapy and Prevention of Thrombosis” guidelines in Chest this week.

The updated guidelines, which include more than 600 recommendations for the prevention, diagnosis, and treatment of thrombosis, emphasize the importance of risk stratification among patients.

“There has been a significant push in health care to administer DVT [deep vein thrombosis] prevention for every patient, regardless of risk. As a result, many patients are receiving unnecessary therapies that provide little benefit and could have adverse effects,” said Guidelines Panel Chair Gordon Guyatt, from McMaster University in Hamilton, Ontario, Canada, in a press statement.

“The decision to administer DVT prevention therapy should be based on the patients' risk and the benefits of prevention or treatment.”

To address this, the ACCP guidelines provide comprehensive risk stratification recommendations for most major clinical areas, including medical, non-orthopedic surgery, orthopedic surgery, pregnancy, cardiovascular disease, atrial fibrillation, stroke, pediatrics, and long-distance travel.

To give an example, the guidelines for long-distance air travel, recommend frequent ambulation, calf muscle stretching, sitting in an aisle seat if possible, or the use of below-knee graduated compression stockings among patients with an increased risk for travel-related DVT/pulmonary embolism (PE).

Conversely, the guidelines suggest there is no definitive evidence to support that dehydration, alcohol intake, or sitting in economy class increases a patient's risk for developing a DVT/PE resulting from long-distance flights. In addition, the guidelines advise against the use of aspirin or anticoagulant therapy to prevent DVT/PE in all but those with a particularly high risk for the conditions.

Another notable recommendation is a revision in the use of aspirin in surgical thromboprophylaxis. Previous ACCP guidelines recommended against using aspirin as the single agent for prophylaxis in any surgical population. In the current edition, the ACCP include aspirin is an option for the prevention of DVT/VTE in major orthopedic surgery.

“Although we are not recommending aspirin as the optimal DVT/VTE [venous thromboembolism] prophylaxis, we have reviewed the existing evidence and concluded that aspirin is an acceptable option in some instances where preventive therapy is needed,” said guideline co-author Mark Crowther, also from McMaster University.

The guidelines also offer recommendations for the use of new oral anticoagulants, namely apixaban, rivaroxaban, and dabigatran etexilate, in select clinical conditions, such as atrial fibrillation and in patients undergoing orthopedic surgery, and provide a detailed analysis of evidence-based management of all anticoagulant therapy.

The authors point out that the “Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines,” were developed using the most critical methods yet.

“The evidence review for the new guidelines was more rigorous than ever before, and our method for grading research studies has become even more stringent,” said another of the authors, David Gutterman (University College of Wisconsin, Milwaukee, USA).

“We believe that the objective rigorous application of the science of guideline development will ultimately best serve our patients,” he concluded.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012

Journal 2012; 141: 1S-801S