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Treatment recommendations for people with clots in 1 or more veins (venous thromboembolism)

Kearon C, Akl EA, Ornelas J, et al. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest. 2016;149:315-52.

Question

Which treatments are recommended by the American College of Chest Physicians for people with clots in veins in their legs, arms, or lungs (also known as venous thromboembolism [VTE] or deep venous thrombosis [DVT] or pulmonary embolism [PE])?

Background

People with venous thromboembolism have blood clots in their veins, usually in the lower leg or thigh. A DVT can be in the inner veins of the leg and above the knee (proximal) or below the knee (distal). Clots can break off and travel within the body, blocking arteries in the lung (pulmonary embolism) and causing lung damage or even death. Antithrombotic drugs (blood thinners) are prescribed to prevent clots from spreading or breaking off.

How the recommendations were developed

The American College of Chest Physicians brought together a group of medical specialists to develop the recommendations. They did a systematic review to find studies on 15 topics related to the care of people with venous thromboembolism. They searched for studies that were published up to July 2014.

The specialists discussed the findings of the studies and developed recommendations based on the available evidence and their clinical experience. The final recommendations had to have more than 80% agreement of the group members.

The recommendations

The group developed a number of strong recommendations, all of which are based on moderate-quality evidence. They are shown in the Table below.

 

Conclusion

The American College of Chest Physicians made recommendations on the best treatments for people with venous thromboembolism.

 

Treatments recommended by the American College of Chest Physicians for people with venous thromboembolism

Recommendations

3 months of anticoagulant treatment should be given to:

  • people with proximal DVT or PE
  • people with DVT of the leg or PE as a complication of surgery
  • people with DVT of the leg or PE caused by a short-term risk factor and not surgery
  • people with just a distal DVT of the leg as a complication of surgery or caused by a short-term risk factor
  • people with unprovoked DVT of the leg or PE (“unprovoked” means without a known cause such as trauma, surgery, or cancer)
  • people with their first unprovoked proximal DVT of the leg or PE who also have high risk for bleeding

Anticoagulant treatment with no scheduled stop date (rather than 3 months) should be given to

  • people with a second unprovoked VTE who have low risk for bleeding
  • people with DVT of the leg or PE who also have active cancer but do not have high risk for bleeding

People with just distal DVT of the leg who are treated with anticoagulants should receive the same type of anticoagulants as people with proximal DVT.

People with just distal DVT of the leg who are managed with repeated imaging (e.g., ultrasound) should not receive anticoagulants if the clot does not extend; if the clot extends into the proximal veins, they should receive anticoagulants.

People with DVT or PE treated with anticoagulants should not receive a filter in their inferior vena cava (this is the major vein carrying blood from the legs to the lungs).

Most people with PE that is not linked to low blood pressure should receive systemic thrombolysis (clot busters).

People with DVT in an upper extremity (arm) who are receiving clot busters should receive the same dose of anticoagulants for the same length of time as people with DVT in an upper extremity who are not receiving clot busters.

DVT = deep venous thrombosis, PE = pulmonary embolism



Related Topics


Glossary

Anticoagulants
Medications that suppress, delay, or prevent blood clots. Anticoagulants (also referred to as "blood thinners") are used to treat circulatory blockages.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

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