Scott M Stevens1, Scott C Woller2, Lisa Baumann Kreuziger3, Henri Bounameaux4, Kevin Doerschug5, Geert-Jan Geersing6, Menno V Huisman7, Clive Kearon1, Christopher S King8, Andrew J Knighton9, Erica Lake10, Susan Murin11, Janine R E Vintch12, Philip S Wells13, Lisa K Moores14. 1. Department of Medicine, Intermountain Healthcare, Murray, UT. 2. Department of Medicine, Intermountain Healthcare, Murray, UT. Electronic address: scott.woller@imail.org. 3. Versiti Blood Research Institute and Medical College of Wisconsin, Milwaukee, WI. 4. Department of Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland. 5. Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, IA. 6. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands. 7. Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands. 8. Advanced Lung Disease and Transplant Clinic, Inova Fairfax Hospital, Falls Church, VA. 9. Healthcare Delivery Institute, Intermountain Healthcare, Murray, UT. 10. Essentia Institute of Rural Health, Duluth, MN. 11. University of California Davis School of Medicine, Davis, CA. 12. Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA. 13. Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, ON, Canada. 14. Department of Medicine, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD.
Abstract
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.
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.
Authors: Romain Chopard; Umberto Campia; Lucas Morin; Karola S Jering; Zaid I Almarzooq; Julia Elizabeth Snyder; Samantha Rizzo; Aaron B Waxman; Samuel Z Goldhaber; Gregory Piazza Journal: J Thromb Thrombolysis Date: 2022-09-03 Impact factor: 5.221