By Amy Orciari Herman
Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM
NEJM Journal Watch
The American Society of Hematology has issued new guidelines on managing venous thromboembolism.
Of the 28 recommendations, published in Blood Advances, 3 are classified as “strong”:
- For patients with pulmonary embolism (PE) and hemodynamic compromise, thrombolytic therapy followed by anticoagulation is recommended over anticoagulation alone.
- For those with deep venous thrombosis (DVT) or PE who have finished primary treatment and will continue a vitamin K antagonist for secondary prevention, an INR range of 2.0–3.0 should be used rather than a lower range.
- For patients with recurrent unprovoked DVT or PE, continuing antithrombotic therapy indefinitely is advised rather than stopping anticoagulation after primary treatment.
The “conditional” recommendations include the following:
- For patients with uncomplicated DVT or PE with a low risk for complications, the group suggests offering home treatment rather than hospital treatment.
- The group suggests using direct oral anticoagulants instead of vitamin K antagonists for the initial treatment of DVT or PE.