In the United States, every year every 1 to 2 individuals per 1000 individuals develop Venous Thromboembolism (VTE) including Pulmonary embolism (PE) and Deep Vein Thrombosis (DVT). This makes 3 to 6 Million total cases of VTE occurrence in the US annually. In most cases, DVT is found in the lower body, but chances are there to be found in the upper body as well. It is estimated that one-third of the patients who are diagnosed with VTE have PE with DVT.
For such serious conditions, options like thrombolytic and Anticoagulant therapies are available to reduce the risk of VTE and help prevent clotting. Particularly, Anticoagulants prevent clotting and disposition of clot further in the body. It uses the natural body mechanism of fibrinolytic to break down the clot.
Anticoagulant therapy is extremely effective to prevent recurrent VTE, but it is characterized by excessive bleeding complications. Every 1% to 3% of patients goes through major bleeding complications. In the following, we have discussed chest guidelines anticoagulation regarding antithrombotic therapy for Venous Thromboembolism (VTE).
Key Points for Chest Guidelines VTE
The American College of Chest Physicians has introduced chest guidelines VTE based on 11 key points. They include;
1. Recommendations for Anticoagulants
For VTE conditions without a cancer diagnosis, all direct anticoagulants are recommended (dabigatran, apixaban, rivaroxaban, edoxaban, etc.) over VKA therapy (Vitamin K antagonist) (grade 2b recommendation) and VKA treatment is preferred over low molecular weight heparin (LMWH – grade 2C). Suggests chest guidelines anticoagulation.
2. Patients with Cancer Diagnosis
For VTE conditions with a cancer diagnosis, LMWH is recommended over other direct oral anticoagulants of all (grade – 2C) or Vitamin K antagonist (VKA) (Grade – 2B).
3. Patients with DVT
For patients with severe DVT (deep venous thrombosis) caused by any surgery, it is recommended to stop giving anticoagulants after therapy of 3 months rather than shorter or longer treatments (Grade – 1B).
4. Pulmonary Embolism
Anticoagulants should be stopped after covering 3 months in patients with DVT or pulmonary embolism caused by non-surgical transient risk factors over shorter or longer treatment courses. Grade 1B – for patients with high bleeding risk, Grade 2B – for low and moderate bleeding risk.
5. Patients having unprovoked DVT
Patients with first unprovoked DVT and patients who have a greater risk of excessive bleeding, anticoagulants must be given to them for 3 months (Grade – 1B). However, in patients with moderate to low risk of bleeding, it should be extended (Grade – 2B).
6. Inferior Vena Cava Filters
For patients who are treated with anticoagulants for severe VTE, it is suggested to not use inferior vena cava filters (Grade 1B).
7. Patients having Proximal DVT
For patients who have unprovoked proximal DVT and have stopped anticoagulant treatment, it is suggested to take aspirin to prevent VTE from occurring again, only if there are no side effects of aspirin treatment (Grade 2B).
8. Use of Compression Stocking
For patients with severe DVT, chest guidelines DVT recommends stopping using compression stockings frequently to reduce the chances of post-thrombotic syndrome (Grade 2B).
9. Patients with Subsegmental PE
Patients who have subsegmental PE without DVT, should be kept under clinical observation when the VTE recurrence chances are low (Grade 2C) while for the patients with high chances of VTE recurrence, chest guidelines suggest using anticoagulants instead of surveillance. (Grade 2C).
10. Patients having Hypotension
For patients who have severe PE and hypotension, it is suggested to use thrombolytic therapy (Grade 2B). It means that the guidelines prefer using systemic therapy over catheter-directed thrombolytic therapy (Grade 2C).
11. Increasing Dose of LMWH
For patients who have recurrent VTE and are being treated with a non-LMWH anticoagulant, the guideline recommends shifting to LMWH treatment (Grade 2C). However, if patients develop recurrent VTE while being treated with LMWH, it is suggested to increase the dose of LMWH (Grade 2C).
The reports estimated that 60,000 to 10,000 Americans die of Venous Thromboembolism. 10% to 30% die within a month after getting diagnosed with this. While 25% of the people who have VTE die a sudden death. According to chest guidelines DVT, among patients who have had DVT, 33% to 50% of them will suffer from long-term complications in the form of post-thrombotic syndrome. It has symptoms like swelling, discoloration, pain, and limb scaling. 33% of the people who had DVT/PE have higher chances of recurrence within 10 years after the treatment. Genetics is another factor that triggers thrombosis and 5% to 8% of the people in the US are at severe risk of inherited thrombophilia. Thereby, these comprehensive chest guidelines for anticoagulation serve as a roadmap for antithrombotic therapy for Venous thromboembolism.
Conclusion
Based on the guidelines shared above, it is recommended that there is certain discouragement of IVC filter use in anticoagulated patients. Moreover, it is necessary for encouragement of indefinite anticoagulant therapy after the first unprovoked PE and lastly, there is also discouragement of the thrombolytic therapy in PE patients who are mainly not hypotensive.