The updated guidelines, which include more than 600 recommendations for the prevention, diagnosis, and treatment of thrombosis, emphasize the importance of risk stratification among patients.

-Team@CMHF

• There has been a significant push in health care to administer DVT [deep vein thrombosis] prevention for every patient, regardless of risk.
• As a result, many patients are receiving unnecessary therapies that provide little benefit and could have adverse effects, said Guidelines Panel Chair Gordon Guyatt, from McMaster University in Hamilton, Ontario, Canada, in a press statement.
• The decision to administer DVT prevention therapy should be based on the patients’ risk and the benefits of prevention or treatment.
• To address this, the ACCP guidelines provide comprehensive risk stratification recommendations for most major clinical areas, including medical, non-orthopedic surgery, orthopedic surgery, pregnancy, cardiovascular disease, atrial fibrillation, stroke, pediatrics, and long-distance travel.
• To give an example, the guidelines for long-distance air travel, recommend frequent ambulation, calf muscle stretching, sitting in an aisle seat if possible, or the use of below-knee graduated compression stockings among patients with an increased risk for travel-related DVT/pulmonary embolism (PE).
• Conversely, the guidelines suggest there is no definitive evidence to support that dehydration, alcohol intake, or sitting in economy class increases patient’s risk for developing a DVT/PE resulting from long-distance flights.
• In addition, the guidelines advise against the use of aspirin or anticoagulant therapy to prevent DVT/PE in all but those with a particularly high risk for the conditions.
• Another notable recommendation is a revision in the use of aspirin in surgical thromboprophylaxis.
• Previous ACCP guidelines recommended against using aspirin as the single agent for prophylaxis in any surgical population. In the current edition, the ACCP include aspirin is an option for the prevention of DVT/VTE in major orthopedic surgery.
• Guideline co-author Mark Crowther said that although it is not recommended that aspirin as the optimal DVT/VTE (venous thromboembolism) prophylaxis, but after reviewing the existing evidence it is concluded that aspirin is an acceptable option in some instances where preventive therapy is needed
• The guidelines also offer recommendations for the use of new oral anticoagulants, namely apixaban, rivaroxaban, and dabigatran etexilate, in select clinical conditions, such as atrial fibrillation and in patients undergoing orthopedic surgery, and provide a detailed analysis of evidence-based management of all anticoagulant therapy.

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