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Kearon C, Akl EA, Ornelas J, et al. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest. 2016;149:315-52.
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])?
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.
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 group developed a number of strong recommendations, all of which are based on moderate-quality evidence. They are shown in the Table below.
The American College of Chest Physicians made recommendations on the best treatments for people with venous thromboembolism.
3 months of anticoagulant treatment should be given to:
Anticoagulant treatment with no scheduled stop date (rather than 3 months) should be given to
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.