Antithrombotic Therapy for VTE Disease

CHEST Journal, vol. 166, pp. 388–404

Abstract

The American College of Chest Physicians (CHEST) Antithrombotic Therapy for Venous Thromboembolism Disease evidence-based guidelines are now updated in a more frequent, focused manner. Guidance statements from the most recent full guidelines and two subsequent updates have not been gathered into a single source. An international panel of experts with experience in prior antithrombotic therapy guideline development reviewed the 2012 CHEST antithrombotic therapy guidelines and its two subsequent updates. All guideline statements and their associated patient, intervention, comparator, and outcome questions were assembled. A modified Delphi process was used to select statements considered relevant to current clinical care. The panel further endorsed minor phrasing changes to match the standard language for guidance statements using the modified Grading of Recommendations, Assessment, Development, and Evaluations (ie, GRADE) format endorsed by the CHEST Guidelines Oversight Committee. The panel appended comments after statements deemed as relevant, including suggesting that statements be updated in future guidelines because of interval evidence. We include 58 guidance statements from prior versions of the antithrombotic therapy guidelines, with updated phrasing as needed to adhere to contemporary nomenclature. Statements were classified as strong or weak recommendations based on high-certainty, moderate-certainty, and low-certainty evidence using GRADE methodology. The panel suggested that five statements are no longer relevant to current practice. As CHEST continues to update guidance statements relevant to antithrombotic therapy for VTE disease, this article serves as a unified collection of currenrtly relevant statements from the preceding three guidelines. Suggestions have been made to update specific statements in future publications.

Authors 12

1. Scott M. Stevens

   Intermountain Healthcare · University of Utah · Intermountain Medical Center

   Affiliation as printed

   Department of Medicine, Intermountain Health, Murray, UT; Department of Internal Medicine, Univeristy of Utah School of Medicine, Salt Lake City, UT

2. Scott C. Woller

   Intermountain Healthcare · University of Utah · Intermountain Medical Center

   Affiliation as printed

   Department of Medicine, Intermountain Health, Murray, UT; Department of Internal Medicine, Univeristy of Utah School of Medicine, Salt Lake City, UT

3. Lisa Baumann Kreuziger

   Medical College of Wisconsin

   Affiliation as printed

   Versiti Blood Research Institute and Medical College of Wisconsin, Milwaukee, WI

4. Kevin C. Doerschug

   University of Iowa

   Affiliation as printed

   Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, IA

5. Geert‐Jan Geersing

   Utrecht University · University Medical Center Utrecht

   Affiliation as printed

   Julius Center for Health Sciences and Primary Care, Department of General Practice and Nursing Science, University Medical Center Utrecht, Utrecht

6. Frederikus Albertus Klok Aachen Dept of Medicine - Thrombosis and Hemostasis

   Leiden University Medical Center

   Affiliation as printed

   Department of Medicine-Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands

7. Christopher S. King

   Inova Fairfax Hospital

   Affiliation as printed

   Advanced Lung Disease and Transplant Clinic, Inova Fairfax Hospital, Falls Church, VA

8. Susan Murin

   University of California, Davis

   Affiliation as printed

   University of California Davis School of Medicine, Sacramento, CA

9. Janine Vintch

   University of California, Los Angeles · The Lundquist Institute · Harbor–UCLA Medical Center

   Affiliation as printed

   Lundquist Institute for Biomedical Innovation, Harbor-UCLA Medical Center, Torrance, CA

10. Philip Stephen Wells

    University of Ottawa · Ottawa Hospital Research Institute

    Affiliation as printed

    Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, ON, Canada

11. Suman M. Wasan

    University of North Carolina at Chapel Hill

    Affiliation as printed

    Department of Medicine, University of North Carolina, Chapel Hill, NC

12. Lisa K. Moores

    Uniformed Services University of the Health Sciences

    Affiliation as printed

    Department of Medicine, F. Edward Hebert School of Medicine, The Uniformed Services University of the Health Sciences, Bethesda MD