The Antithrombotic Therapy and Prevention of Thrombosis Evidence-Based Clinical Practice Guidelines was published in the February, 2012 issue of the journal CHEST. The rigorousness of methodology and the appraisal of evidence used in this version of the guidelines have lead to a fewer strong 1A recommendations compared to the last report. This version of the guidelines also included, for the first time, a chapter on diagnosis and addressing patients with symptoms and signs suggesting deep vein thrombosis.
Highlights of this version include the following:
- Prophylaxis for all patients: Clinicians are now urged to risk stratify their patients in terms of risks for VTE and risks for bleeding before administering a preventive therapy. The guidelines provide comprehensive risk stratification recommendations for most major clinical areas.
- Long-distance flights: The authors identify several predisposing factors for developing a VTE episode. These include the presence of a previous VTE or known thrombophilic disorder; malignancy; recent surgery or trauma; immobility; estrogen use or pregnancy; and sitting in a window seat. The guidelines therefore recommend frequent ambulation, calf muscle stretching, sitting in an aisle seat if possible, or the use of graduated compression stockings.
- Aspirin for VTE prevention: Previous ACCP guidelines recommended against using aspirin as the single agent for prophylaxis in any surgical population. In the current edition, the ACCP has revised this recommendation and indicates that aspirin is an option but not the agent of choice for the prevention of VTE in major orthopedic surgery.
The guidelines are endorsed by the following medical associations: the American Association for Clinical Chemistry, American College of Clinical Pharmacy, American Society of Health-System Pharmacists, American Society of Hematology, International Society of Thrombosis and Hemostasis, and the American College of Obstetrics and Gynecology.
Guyatt GH, Akl EA, Crowther MA, et al; for the American College of Chest Physicians Antithrombotic Therapy and the Prevention of Thrombosis Panel. Executive Summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Guidelines. CHEST.