American Society of Hematology 2020 Guidelines for Management of Venous Thromboembolism: Treatment of Deep Vein Thrombosis and Pulmonary Embolism
In August 2022, these guidelines were reviewed by an expert work group convened by ASH. Review included limited searches for new evidence and discussion of the search results. Following this review, the ASH Committee on Quality agreed to continue monitoring the supporting evidence rather than revise...
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| Published in | Blood advances Vol. 4; no. 19; pp. 4693 - 4738 |
|---|---|
| Main Authors | , , , , , , , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Elsevier Inc
13.10.2020
American Society of Hematology |
| Subjects | |
| Online Access | Get full text |
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| Abstract | In August 2022, these guidelines were reviewed by an expert work group convened by ASH. Review included limited searches for new evidence and discussion of the search results. Following this review, the ASH Committee on Quality agreed to continue monitoring the supporting evidence rather than revise or retire these guidelines at this time. Limited searches and expert review will be repeated annually going forward until these guidelines are revised or retired.
Background: Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), occurs in ∼1 to 2 individuals per 1000 each year, corresponding to ∼300 000 to 600 000 events in the United States annually.
Objective: These evidence-based guidelines from the American Society of Hematology (ASH) intend to support patients, clinicians, and others in decisions about treatment of VTE.
Methods: ASH formed a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline development process, including updating or performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and adult patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence and make recommendations, which were subject to public comment.
Results: The panel agreed on 28 recommendations for the initial management of VTE, primary treatment, secondary prevention, and treatment of recurrent VTE events.
Conclusions: Strong recommendations include the use of thrombolytic therapy for patients with PE and hemodynamic compromise, use of an international normalized ratio (INR) range of 2.0 to 3.0 over a lower INR range for patients with VTE who use a vitamin K antagonist (VKA) for secondary prevention, and use of indefinite anticoagulation for patients with recurrent unprovoked VTE. Conditional recommendations include the preference for home treatment over hospital-based treatment for uncomplicated DVT and PE at low risk for complications and a preference for direct oral anticoagulants over VKA for primary treatment of VTE. |
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| AbstractList | Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), occurs in ∼1 to 2 individuals per 1000 each year, corresponding to ∼300 000 to 600 000 events in the United States annually.
These evidence-based guidelines from the American Society of Hematology (ASH) intend to support patients, clinicians, and others in decisions about treatment of VTE.
ASH formed a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline development process, including updating or performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and adult patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence and make recommendations, which were subject to public comment.
The panel agreed on 28 recommendations for the initial management of VTE, primary treatment, secondary prevention, and treatment of recurrent VTE events.
Strong recommendations include the use of thrombolytic therapy for patients with PE and hemodynamic compromise, use of an international normalized ratio (INR) range of 2.0 to 3.0 over a lower INR range for patients with VTE who use a vitamin K antagonist (VKA) for secondary prevention, and use of indefinite anticoagulation for patients with recurrent unprovoked VTE. Conditional recommendations include the preference for home treatment over hospital-based treatment for uncomplicated DVT and PE at low risk for complications and a preference for direct oral anticoagulants over VKA for primary treatment of VTE. In August 2022, these guidelines were reviewed by an expert work group convened by ASH. Review included limited searches for new evidence and discussion of the search results. Following this review, the ASH Committee on Quality agreed to continue monitoring the supporting evidence rather than revise or retire these guidelines at this time. Limited searches and expert review will be repeated annually going forward until these guidelines are revised or retired. Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), occurs in ∼1 to 2 individuals per 1000 each year, corresponding to ∼300 000 to 600 000 events in the United States annually. Objective: These evidence-based guidelines from the American Society of Hematology (ASH) intend to support patients, clinicians, and others in decisions about treatment of VTE. Methods: ASH formed a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline development process, including updating or performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and adult patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence and make recommendations, which were subject to public comment. Results: The panel agreed on 28 recommendations for the initial management of VTE, primary treatment, secondary prevention, and treatment of recurrent VTE events. Conclusions: Strong recommendations include the use of thrombolytic therapy for patients with PE and hemodynamic compromise, use of an international normalized ratio (INR) range of 2.0 to 3.0 over a lower INR range for patients with VTE who use a vitamin K antagonist (VKA) for secondary prevention, and use of indefinite anticoagulation for patients with recurrent unprovoked VTE. Conditional recommendations include the preference for home treatment over hospital-based treatment for uncomplicated DVT and PE at low risk for complications and a preference for direct oral anticoagulants over VKA for primary treatment of VTE. In August 2022, these guidelines were reviewed by an expert work group convened by ASH. Review included limited searches for new evidence and discussion of the search results. Following this review, the ASH Committee on Quality agreed to continue monitoring the supporting evidence rather than revise or retire these guidelines at this time. Limited searches and expert review will be repeated annually going forward until these guidelines are revised or retired. Background: Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), occurs in ∼1 to 2 individuals per 1000 each year, corresponding to ∼300 000 to 600 000 events in the United States annually. Objective: These evidence-based guidelines from the American Society of Hematology (ASH) intend to support patients, clinicians, and others in decisions about treatment of VTE. Methods: ASH formed a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline development process, including updating or performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and adult patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence and make recommendations, which were subject to public comment. Results: The panel agreed on 28 recommendations for the initial management of VTE, primary treatment, secondary prevention, and treatment of recurrent VTE events. Conclusions: Strong recommendations include the use of thrombolytic therapy for patients with PE and hemodynamic compromise, use of an international normalized ratio (INR) range of 2.0 to 3.0 over a lower INR range for patients with VTE who use a vitamin K antagonist (VKA) for secondary prevention, and use of indefinite anticoagulation for patients with recurrent unprovoked VTE. Conditional recommendations include the preference for home treatment over hospital-based treatment for uncomplicated DVT and PE at low risk for complications and a preference for direct oral anticoagulants over VKA for primary treatment of VTE. Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), occurs in ∼1 to 2 individuals per 1000 each year, corresponding to ∼300 000 to 600 000 events in the United States annually.BACKGROUNDVenous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), occurs in ∼1 to 2 individuals per 1000 each year, corresponding to ∼300 000 to 600 000 events in the United States annually.These evidence-based guidelines from the American Society of Hematology (ASH) intend to support patients, clinicians, and others in decisions about treatment of VTE.OBJECTIVEThese evidence-based guidelines from the American Society of Hematology (ASH) intend to support patients, clinicians, and others in decisions about treatment of VTE.ASH formed a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline development process, including updating or performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and adult patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence and make recommendations, which were subject to public comment.METHODSASH formed a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline development process, including updating or performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and adult patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence and make recommendations, which were subject to public comment.The panel agreed on 28 recommendations for the initial management of VTE, primary treatment, secondary prevention, and treatment of recurrent VTE events.RESULTSThe panel agreed on 28 recommendations for the initial management of VTE, primary treatment, secondary prevention, and treatment of recurrent VTE events.Strong recommendations include the use of thrombolytic therapy for patients with PE and hemodynamic compromise, use of an international normalized ratio (INR) range of 2.0 to 3.0 over a lower INR range for patients with VTE who use a vitamin K antagonist (VKA) for secondary prevention, and use of indefinite anticoagulation for patients with recurrent unprovoked VTE. Conditional recommendations include the preference for home treatment over hospital-based treatment for uncomplicated DVT and PE at low risk for complications and a preference for direct oral anticoagulants over VKA for primary treatment of VTE.CONCLUSIONSStrong recommendations include the use of thrombolytic therapy for patients with PE and hemodynamic compromise, use of an international normalized ratio (INR) range of 2.0 to 3.0 over a lower INR range for patients with VTE who use a vitamin K antagonist (VKA) for secondary prevention, and use of indefinite anticoagulation for patients with recurrent unprovoked VTE. Conditional recommendations include the preference for home treatment over hospital-based treatment for uncomplicated DVT and PE at low risk for complications and a preference for direct oral anticoagulants over VKA for primary treatment of VTE. |
| Author | Manja, Veena Witt, Daniel M. Nieuwlaat, Robby Neumann, Ignacio Thurston, Caitlin Vedantham, Suresh Verhamme, Peter Jaff, Michael R. Wiercioch, Wojtek Beyth, Rebecca Hutten, Barbara A. D. Florez, Ivan Izcovich, Ariel Cuker, Adam Schulman, Sam Ortel, Thomas L. J. Schünemann, Holger Zhang, Yuqing Clark, Nathan P. Ross, Stephanie Zhang, Yuan Ageno, Walter |
| Author_xml | – sequence: 1 givenname: Thomas L. orcidid: 0000-0001-6193-4585 surname: Ortel fullname: Ortel, Thomas L. email: thomas.ortel@duke.edu organization: Division of Hematology, Department of Medicine, Duke University, Durham NC – sequence: 2 givenname: Ignacio surname: Neumann fullname: Neumann, Ignacio organization: Pontificia Universidad Catolica de Chile, Santiago, Chile – sequence: 3 givenname: Walter surname: Ageno fullname: Ageno, Walter organization: Department of Medicine and Surgery, University of Insurbria, Varese, Italy – sequence: 4 givenname: Rebecca orcidid: 0000-0003-1727-1133 surname: Beyth fullname: Beyth, Rebecca organization: Division of General Internal Medicine, Department of Medicine, University of Florida, Gainesville, FL – sequence: 5 givenname: Nathan P. orcidid: 0000-0002-9289-7710 surname: Clark fullname: Clark, Nathan P. organization: Clinical Pharmacy Anticoagulation Service, Kaiser Permanente, Aurora, CO – sequence: 6 givenname: Adam orcidid: 0000-0002-3595-5697 surname: Cuker fullname: Cuker, Adam organization: Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA – sequence: 7 givenname: Barbara A. orcidid: 0000-0002-9243-0037 surname: Hutten fullname: Hutten, Barbara A. organization: Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands – sequence: 8 givenname: Michael R. orcidid: 0000-0002-3772-5887 surname: Jaff fullname: Jaff, Michael R. organization: Harvard Medical School, Boston, MA – sequence: 9 givenname: Veena orcidid: 0000-0003-0410-8089 surname: Manja fullname: Manja, Veena organization: University of California Davis, Sacramento, CA – sequence: 10 givenname: Sam surname: Schulman fullname: Schulman, Sam organization: Department of Medicine, Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, ON, Canada – sequence: 11 givenname: Caitlin surname: Thurston fullname: Thurston, Caitlin organization: May-Thurner Syndrome Resource Network – sequence: 12 givenname: Suresh surname: Vedantham fullname: Vedantham, Suresh organization: Division of Diagnostic Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO – sequence: 13 givenname: Peter surname: Verhamme fullname: Verhamme, Peter organization: KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium – sequence: 14 givenname: Daniel M. orcidid: 0000-0002-3930-8358 surname: Witt fullname: Witt, Daniel M. organization: Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT – sequence: 15 givenname: Ivan orcidid: 0000-0002-0751-8932 surname: D. Florez fullname: D. Florez, Ivan organization: Department of Pediatrics, University of Antioquia, Medellin, Colombia – sequence: 16 givenname: Ariel orcidid: 0000-0001-9053-4396 surname: Izcovich fullname: Izcovich, Ariel organization: Internal Medicine Department, German Hospital, Buenos Aires, Argentina; and – sequence: 17 givenname: Robby surname: Nieuwlaat fullname: Nieuwlaat, Robby organization: Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada – sequence: 18 givenname: Stephanie surname: Ross fullname: Ross, Stephanie organization: Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada – sequence: 19 givenname: Holger orcidid: 0000-0003-3211-8479 surname: J. Schünemann fullname: J. Schünemann, Holger organization: Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada – sequence: 20 givenname: Wojtek orcidid: 0000-0001-6576-1650 surname: Wiercioch fullname: Wiercioch, Wojtek organization: Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada – sequence: 21 givenname: Yuan surname: Zhang fullname: Zhang, Yuan organization: Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada – sequence: 22 givenname: Yuqing surname: Zhang fullname: Zhang, Yuqing organization: Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/33007077$$D View this record in MEDLINE/PubMed |
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| Snippet | In August 2022, these guidelines were reviewed by an expert work group convened by ASH. Review included limited searches for new evidence and discussion of the... Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), occurs in ∼1 to 2 individuals per 1000 each year,... |
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| SubjectTerms | Clinical Guidelines Evidence-Based Medicine Hematology Humans Pulmonary Embolism - drug therapy United States Venous Thromboembolism - drug therapy Venous Thrombosis - drug therapy |
| Title | American Society of Hematology 2020 Guidelines for Management of Venous Thromboembolism: Treatment of Deep Vein Thrombosis and Pulmonary Embolism |
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