Chest
Volume 160, Issue 6, December 2021, Pages 2247-2259
Journal home page for Chest

Pulmonary Vascular: Guidelines and Consensus Statements
Executive Summary: Antithrombotic Therapy for VTE Disease: Second Update of the CHEST Guideline and Expert Panel Report

https://doi.org/10.1016/j.chest.2021.07.056Get rights and content

Background

This is the 2nd update to the 9th edition of these guidelines. We provide recommendations on 17 PICO (Population, Intervention, Comparator, Outcome) questions, four of which have not been addressed previously.

Methods

We generate strong and weak recommendations based on high-, moderate-, and low-certainty evidence, using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology.

Results

The panel generated 29 guidance statements, 13 of which are graded as strong recommendations, covering aspects of antithrombotic management of VTE from initial management through secondary prevention and risk reduction of postthrombotic syndrome. Four new guidance statements have been added that did not appear in the 9th edition (2012) or 1st update (2016). Eight statements have been substantially modified from the 1st update.

Conclusion

New evidence has emerged since 2016 that further informs the standard of care for patients with VTE. Substantial uncertainty remains regarding important management questions, particularly in limited disease and special patient populations.

Key Words

antithrombotic therapy
DVT
guidelines
pulmonary embolism
thrombosis

Abbreviations

AC
anticoagulation
APS
antiphospholipid syndrome
ASH
American Society of Hematology
AT9
Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
CAT
cancer-associated thrombosis
CDT
catheter-directed thrombolysis
CVT
cerebral vein thrombosis
DOAC
direct-acting oral anticoagulant
ESC
European Society of Cardiology
EtD
evidence-to-decision
ISSPE
isolated subsegmental pulmonary embolism
IVC
inferior vena cava
LMWH
low-molecular-weight heparin
NICE
National Institute for Health and Care Excellence
PE
pulmonary embolism
PICO
Population, Intervention, Comparator, Outcome
PTS
postthrombotic syndrome
SVT
superficial venous thrombosis
VKA
vitamin K antagonist

Cited by (0)

DISCLAIMER: American College of Chest Physician guidelines are intended for general information only, are not medical advice, and do not replace professional medical care and physician advice, which always should be sought for any medical condition. The complete disclaimer for this guideline can be accessed at https://www.chestnet.org/Guidelines-and-Resources.

FUNDING/SUPPORT: This guideline was supported solely by internal funds from the American College of Chest Physicians.

View Abstract