dvt treatment guidelines 2020

In Part A of the forms, individuals disclosed material interests for 2 years prior to appointment. The ASH VTE treatment guideline panel has provided a conditional recommendation for the use of DOACs over VKAs as treatment for patients with a new diagnosis of VTE. We estimated an annualized risk for major bleeding of 2.1% assuming a risk for major bleeding close to 0 after anticoagulant discontinuation. We received comments and additional references from 17 individuals and organizations. Indefinite antithrombotic therapy also showed a risk reduction in DVT (RR, 0.20; 95% CI, 0.12-0.34; ARR, 50 fewer per 1000 patients; 95% CI, 56 fewer to 42 fewer; high-certainty evidence). The longer course of therapy varied from 6 months to 24 months.262  Patients were followed after the end of the extended anticoagulation treatment. These patients may have ≥1 nonenvironmental risk factor for recurrent VTE, such as inherited thrombophilia, older age, and/or male sex, but these variables would not affect this recommendation concerning the duration of the primary treatment phase for the thromboembolic event. Four Markov model analyses of cost-effectiveness for a longer course of antithrombotic therapy vs a shorter course of antithrombotic therapy for VTE treatment were identified. The evidence-to-decision (EtD) framework for each recommendation describes which individuals were recused from making judgments about each recommendation. The target audience includes patients, hematologists, general practitioners, internists, hospitalists, vascular interventionalists, intensivists, other clinicians, pharmacists, and decision-makers. Each EtD table addressed the effects of interventions, resource use (cost effectiveness), values and preferences (relative importance of outcomes), equity, acceptability, and feasibility. Recommendations 20 to 22 address the antithrombotic therapies that might be considered for patients who continue indefinite therapy. Thrombolytic therapy can be an appropriate intervention in selected patients with PE, as described in Recommendations 6 and 7, and can be administered systemically or using a catheter-directed approach. In addition to synthesizing evidence systematically, the McMaster GRADE Centre supported the guideline-development process, including determining methods, preparing agendas and meeting materials, and facilitating panel discussions. or pulmonary embolism (PE). Three analyses showed that the extended strategy was cost-effective compared with limited antithrombotic therapy,112,270,271  whereas 1 analysis suggested that longer initial conventional-intensity anticoagulation with warfarin was cost-effective in younger patients, and 3 months of anticoagulation was preferred in elderly patients (≥80 years old).272  The panel considered that cost-effectiveness varies with patients, the chronic risk factor(s) contributing to risk of recurrent VTE, and the antithrombotic therapy used. However, when we considered only the trials with a low risk for bias, this potential benefit was not observed (RR, 1.01; 95% CI, 0.76-1.33). The trials identified primarily included patients without hemodynamic compromise, and the panel judged that thrombolytic effect may be different in such patients. For patients who are going to discontinue anticoagulant therapy after completion of the primary treatment phase, the role of aspirin can be considered but needs to be individualized. When using a VKA or LMWH for indefinite anticoagulation, the risk of DVT was likely reduced in the study population (RR, 0.17; 95% CI, 0.05-0.53; ARR, 54 fewer per 1000 patients; 95% CI, 61 fewer to 30 fewer; moderate-certainty evidence), as well as for patients with unprovoked VTE (ARR, 34 fewer per 1000 patients, 95% CI, 39 fewer to 19 fewer; high-certainty evidence).269,274  Aspirin also likely reduced the risk of DVT for the study population (RR, 0.55; 95% CI, 0.31-0.98; ARR, 64 fewer per 1000 patients, 95% CI, 98 fewer to 3 fewer; moderate-certainty evidence), as well as for patients with unprovoked VTE (ARR, 18 fewer per 1000 patients; 95% CI, 28 fewer to 1 fewer; moderate-certainty evidence).269,274  Our analysis showed a nonsignificant decrease in mortality when using indefinite antithrombotic therapy compared with a defined duration of anticoagulation (RR, 0.75; 95% CI, 0.49-1.13; ARR, 5 fewer per 1000 patients; 95% CI, 9 fewer to 2 more; moderate-certainty evidence). Active cancer is addressed in a future guideline document from ASH and is not considered in this article. Using a DOAC for the longer course of anticoagulation reduced the risk of DVT in the study population (RR, 0.21; 95% CI, 0.11-0.41; ARR, 62 fewer per 1000 patients; 95% CI, 70 fewer to 46 fewer; moderate-certainty evidence), as well as in a low-risk population268  (ARR, 18 fewer per 1000 patients; 95% CI, 21 fewer to 14 fewer; high-certainty evidence). Patients were randomized to receive 20 mg of rivaroxaban or 100 mg of aspirin for 12 months. This recommendation applies to the patient who sustains an unprovoked VTE and who also has a history of an unprovoked VTE that was treated with a time-limited course of therapy that had been discontinued prior to the current event. Similar outcomes were seen for the risk of PE for the study population (RR, 0.84; 95% CI, 0.43-1.66; ARR, 13 fewer per 1000 patients; 95% CI, 47 fewer to 55 more), as well as for a low-risk population274  (ARR, 7 fewer per 1000 patients; 95% CI, 25 fewer to 29 more; moderate-certainty evidence). Patients in these categories who value rapid resolution of symptoms, are averse to the possibility of PTS, and accept the added risk of major bleeding may prefer thrombolysis. For patients with DVT, with (Recommendation 27) or without (Recommendation 28) an increased risk for PTS, the ASH guideline panel suggests against the routine use of compression stockings (conditional recommendations based on very low certainty in the evidence of effects ⨁○○○). During this rating process, the panel used definitions of the outcomes (“marker states”) that were developed for these guidelines. These guidelines are primarily intended to help clinicians make decisions about treatment alternatives. The EtD table summarized the results of systematic reviews of the literature that were conducted for these guidelines. All of the identified trials, with the exception of the SOX trial, compared the use of stockings vs no stockings for patients with proximal DVT. Most trials included patients without hemodynamic compromise but with ultrasonography or biomarkers compatible with right ventricular dysfunction (submassive PE). Policy makers interested in these guidelines include those involved in developing local, national, or international programs aiming to reduce the incidence of VTE or to evaluate direct and indirect harms and costs related to VTE. Although ASH guidelines have a global scope, the recommendations in this article were developed primarily for North America. Finally, catheter-directed thrombolysis is not universally available, given that specialized laboratory support and trained personnel are required, and it might not be acceptable for some stakeholders. Local guideline groups may reuse the evidence collected and appraised on the frameworks. For patients who develop a DVT and/or PE provoked by a transient risk factor and have a history of a previous thrombotic event also provoked by a transient risk factor, the ASH guideline panel suggests stopping anticoagulation after completion of the primary treatment phase of therapy over indefinite duration therapy (conditional recommendation based on moderate certainty in the evidence of effects ⨁⨁⨁○). Deep vein thrombosis (DVT) is the formation of a thrombus (blood clot) in a deep vein, usually in the legs, which partially or completely obstructs blood flow. The lower DOAC dose had little impact on the risk of DVT (RR, 0.75; 95% CI, 0.36-1.53; ARR, 2 fewer per 1000 patients; 95% CI, 6 fewer to 5 more; moderate-certainty evidence) or the risk of major bleeding (RR, 0.97; 95% CI, 0.12-1.95; ARR, 0 fewer per 1000 patients; 95% CI, 2 fewer to 7 more; moderate-certainty evidence). For patients with DVT and/or PE who have completed primary treatment and will continue VKA therapy as secondary prevention, the ASH guideline panel recommends using an international normalized ratio (INR) range of 2.0 to 3.0 over a lower INR range (eg, 1.5-1.9) (strong recommendation based on moderate certainty in the evidence of effects ⨁⨁⨁○). Results from an individual-level meta-analysis, Predicting disease recurrence in patients with previous unprovoked venous thromboembolism: the DASH prediction score, Predicting disease recurrence in patients with previous unprovoked venous thromboembolism: a proposed prediction score (DASH), Clinical prediction guide to predict thrombosis recurrence after a first unprovoked venous thromboembolism. We considered that the avoidance of PE, DVT, and major bleeding was critical for patients. The same occurred with the risk of DVT. The EtD framework is shown online at: https://guidelines.gradepro.org/profile/B7293C21-767F-B3F8-8BB2-A4E5173CDAC3. The ASH guideline panel has provided a conditional recommendation favoring anticoagulation with LMWH over a DOAC, but this recommendation is based on very low certainty in the evidence of effects. For major bleeding, the certainty in the evidence was judged low because of serious risk of bias and imprecision. Remarks: These recommendations are intended to address the duration of primary anticoagulant treatment for all patients with DVT and/or PE, defined as the minimal length of time for treatment of the initial VTE (Figure 2). The certainties of the evidence were judged moderate because of imprecision. The 3 models include D-dimer testing but differ with regard to the additional clinical characteristics considered. It also covers testing for conditions that can make a DVT or PE more likely, such as thrombophilia (a blood clotting disorder) and cancer. For primary treatment of patients with DVT and/or PE, whether provoked by a transient risk factor (Recommendation 12) or a chronic risk factor (Recommendation 13) or unprovoked (Recommendation 14), the ASH guideline panel suggests using a shorter course of anticoagulation for primary treatment (3-6 months) over a longer course of anticoagulation for primary treatment (6-12 months) (conditional recommendations based on moderate certainty in the evidence of effects ⨁⨁⨁○). The use of thrombolytics for patients with DVT may reduce the risk of PTS (RR, 0.70; 95% CI, 0.59-0.83; ARR, 169 fewer per 1000 patients; 95% CI, 96 fewer to 231 fewer; low-certainty evidence) without significantly impacting mortality (RR, 0.77; 95% CI, 0.26-2.28; ARR, 0 fewer per 1000 patients; 95% CI, 1 fewer to 1 more; low-certainty evidence), the risk of PE (RR, 1.33; 95% CI, 0.71-2.46; ARR, 5 more per 1000 patients; 95% CI, 4 fewer to 21 more; low-certainty evidence), or the risk of DVT (RR, 0.99; 95% CI, 0.56-1.76; ARR, 1 fewer per 1000 patients; 95% CI, 57 fewer to 99 more; low-certainty evidence). Additionally, 3 observational studies reported mortality and major bleeding at 3 months follow-up, and 1 reported PE at 3 months. See NICE's information on prescribing medicines. Primary treatment continues anticoagulant therapy for 3 to 6 months total and represents the minimal duration of treatment for the VTE. For patients with breakthrough DVT and/or PE during therapeutic VKA treatment, the ASH guideline panel suggests using low-molecular-weight heparin (LMWH) over DOAC therapy (conditional recommendation based on very low certainty in the evidence of effects ⨁○○○). These patients need to undergo decisions about initial management (Recommendations 1 to 11) and primary treatment (Recommendations 12 to 14), just as with their first event. Approximately 3% to 5% of patients with an acute PE present with hemodynamic compromise, defined as a systolic blood pressure <90 mm Hg or a decrease in systolic blood pressure ≥40 mm Hg from baseline.205,206  These patients are at a significantly greater risk for mortality, as high as 50% by 90 days,205  compared with patients with acute PE who do not present with hemodynamic compromise. Patients placed a high value on the benefits of risk reduction in VTE recurrence and PTS.311  However, there is important variability in how individual patients may value the risk of recurrent VTE vs the risk of bleeding. Patients were randomized to receive placebo or continue treatment for ≥6 months. Remarks: This recommendation does not apply to patients who have other conditions that would require hospitalization, have limited or no support at home, and cannot afford medications or have a history of poor compliance. The panel agreed on 28 recommendations for the initial management of VTE, primary treatment, secondary prevention, and treatment of recurrent VTE events. Trials included individuals with an objectively confirmed symptomatic proximal DVT or PE. Are direct oral anticoagulants equally effective in reducing deep vein thrombosis and pulmonary embolism? Additionally, thrombolytic therapy might reduce the risk of subsequent PE (RR, 0.56; 95% CI, 0.35-0.91; ARR, 7 fewer per 1000 patients; 95% CI, 10 fewer to 2 fewer; very-low-certainty evidence) and DVT (RR, 0.92; 95% CI, 0.14-6.03; ARR, 1 fewer per 1000 patients; 95% CI, 8 fewer to 46 more; very-low-certainty evidence). During deliberations, panel members with a current direct financial conflict of interest in a commercial entity with any product that could be affected by the guidelines were recused from making judgments about relevant recommendations. Several additional variables need to be taken into consideration when selecting an anticoagulant for an individual patient. The panel considered a negligible cost and savings between the interventions. When using a DOAC for a longer course of anticoagulation, the risk of DVT was reduced in the study population (RR, 0.21; 95% CI, 0.11-0.41; ARR, 62 fewer per 1000 patients; 95% CI, 70 fewer to 46 fewer; high-certainty evidence), as well as in a low-risk population268  (ARR, 32 fewer per 1000 patients; 95% CI, 36 fewer to 24 fewer; moderate-certainty evidence). The certainties in the evidence were judged moderate because of imprecision. thrombolysis is suggested over systemic thrombolysis. Individuals with significant renal impairment, as indicated by an estimated creatinine clearance <25 mL/min (apixaban) or 30 mL/min (all other DOACs) and patients at high risk for bleeding were excluded. A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. 1: Introduction, GRADE guidelines: 1. Patients were subsequently randomized to receive placebo or continue antithrombotic therapy for ≥6 additional months. In most patients with proximal DVT, anticoagulation alone is suggested over adding (PE) at low risk for complications, offering home treatment over hospital treatment Patients placed a high value on the benefits of risk reduction in VTE recurrence and PTS.311  However, there is important variability in how individual patients may value the risk of recurrent VTE vs the risk of bleeding. Blood Adv 2020; 4 (19): 4693–4738. As noted above, in the case of prognostic scores, at the time of our systematic review, we did not find any trial assessing their impact in patient-important outcomes, and the evidence regarding their discrimination ability and their validation was limited. We identified 2 RCTs306,314  to inform this recommendation. For the baseline risk of major bleeding, we used data from 2 randomized trials on people with VTE, which showed that the risk of major bleeding with placebo during 18 months or 24 months of follow-up was as low as 0.5%306  and as high as 1.5% in 18 months.259  The EtD framework is shown online at: https://guidelines.gradepro.org/profile/B4FEBCC9-DEB2-C7FE-9420-79D262F2AB0F. Does prescription of medical compression prevent development of post-thrombotic syndrome after proximal deep venous thrombosis? For patients with DVT and/or PE with stable CVD who initiate anticoagulation and were previously taking aspirin for cardiovascular risk modification, the ASH guideline panel suggests suspending aspirin over continuing it for the duration of anticoagulation therapy (conditional recommendation based on very low certainty in the evidence of effects ⨁○○○). ACP Internist is an award-winning publication: evidence-based guidelines from the American Society of Hematology (ASH) included 28 Clinical study of venous filter implantation combined with catheterization thrombolytic therapy for deep vein thrombosis [in Chinese]. Recommendations 12, 13, and 14 address the question of the appropriate duration of time that should be used for primary treatment of the acute event, as defined in Figure 2. The certainty in the evidence was judged low for mortality because of the reasons mentioned above, as well as the large unexplained heterogeneity. Supplement 3 provides the complete “Disclosure of Interests” forms of researchers who contributed to these guidelines. The EtD framework is shown online at: https://guidelines.gradepro.org/profile/A269DB76-A3AE-4994-A718-6F1E493D0A75. Remarks: Indefinite anticoagulation is probably appropriate for the majority of patients with unprovoked VTE. For the baseline risk of major bleeding, we used a meta-analysis of 13 prospective cohort studies and 56 randomized trials98  in VTE patients showing a 2.1% risk for major bleeding during a 6-month period of treatment with anticoagulants. The treatment of distal (below the knee) deep vein thrombosis (DVT) is not clearly established. recommendations and were published Oct. 2 in Blood Advances. For patients with DVT and/or PE with stable cardiovascular disease (CVD) who initiate anticoagulation and were previously taking aspirin for cardiovascular risk modification, the ASH guideline panel suggests suspending aspirin over continuing it for the duration of anticoagulation therapy (conditional recommendation based on very low certainty in the evidence of effects ⨁○○○). The individual recommendations reference 3 patient populations: those with VTE provoked by transient risk factors (Recommendation 12), those with VTE provoked by chronic (persistent) risk factors (Recommendation 13), and those with VTE not associated with any provoking risk factors (ie, unprovoked VTE; Recommendation 14). In this setting, the VKA should be discontinued, the anticoagulant effect should be reversed with vitamin K, and the patient should be started on a nonheparin anticoagulant. For the purpose of this question, aspirin was considered the intervention, and rivaroxaban was the comparator. The certainty in the evidence was judged moderate for mortality, major bleeding, PE, and DVT because of imprecision, given a small number of events in both treatment arms that did not meet the optimal information size and the fact that the CIs around the absolute estimates likely crossed the thresholds that patients would consider important. To diagnose deep vein thrombosis, your doctor will ask you about your symptoms. However, we rated down the certainty in the evidence 1 additional step because of indirectness, given that the trial identified did not really test the use of the D-dimer to make the decision whether to stop or continue anticoagulation. Given the lack of evidence of the comparative effectiveness of different DOACs, we were unable to estimate the benefits and harms of specific agents. Clinicians must make decisions on the basis of the clinical presentation of each individual patient, ideally through a shared decision-making process that considers the patient’s values and preferences with respect to the anticipated outcomes of the chosen option. model implemented by ASH can be easily updated in the future, adding new recommendations However, they may help to select patients with PE at low risk for complications. For patients with PE and hemodynamic compromise, the ASH guideline panel recommends using thrombolytic therapy followed by anticoagulation over anticoagulation alone (strong recommendation despite low certainty in the evidence of effects ⨁⨁○○). Other variables that may impact the choice of anticoagulant therapy for individual patients include the cost of the DOACs and patient preference for once- or twice-daily dosing. Patients with submassive (ie, intermediate-high risk) or massive PE or at high risk for bleeding and those requiring IV analgesics may benefit from initial treatment in the hospital. The EtD framework is shown online at: https://guidelines.gradepro.org/profile/09FEF3FA-8317-EA74-8F3D-5106CF1B80EB. We identified 24 systematic reviews62-85  and 12 randomized trials86-97  (n = 28 876). We tested whether the risk of major bleeding varied with the different routes of administration (ie, systemic vs locoregional vs catheter directed) and found that major bleeding was increased, regardless of the strategy used (RR for systemic infusion, 1.74; RR for catheter-directed infusion, 3.77; RR for locoregional infusion, 4.14). The panel considered that a low target INR with warfarin was probably feasible but not acceptable to key stakeholders. Remarks: Given the very-low-certainty evidence (uncertainty regarding the benefits and harms of catheter-directed thrombolysis compared with systemic thrombolysis), the panel followed the GRADE rules and issued a conditional recommendation. In contrast, estimates of the safety and efficacy of systemic thrombolysis are more confident, having been derived from many randomized trials comprising a much larger number of patients. A wandlike device (transducer) placed over the part of your body where there's a clot sends sound waves into the area. Subsequently, a study investigating the HERDOO2 rule showed that women with a first unprovoked VTE and 0 or 1 of the HERDOO2 criteria could safely discontinue anticoagulant therapy after completing 5 to 12 months of therapeutic anticoagulation as primary treatment.305. Distal DVT can either be treated with anticoagulation, or monitored with close follow-up to detect progression to the proximal veins (above the knee), which requires anticoagulation. It is the standard imaging test to diagnose DVT. We identified 1 RCT316  to inform this recommendation. The certainties of the evidence were judged moderate because of imprecision. On occasion, a strong recommendation is based on low or very low certainty in the evidence. Thrombolytics were systemically infused in all of the trials with the exception of 1,190  in which it was catheter directed. Implementation of this recommendation depends on the ability to rapidly evaluate patients, confirm the diagnosis of PE and associated hemodynamic compromise, and initiate appropriate therapy. First, there needs to be a systematic approach to determine which individuals with PE can be considered for outpatient management.61  Several assessment tools that use baseline clinical information to identify patients at low risk for adverse events during the first few months after diagnosis of PE have been developed, but these prognostic risk scores have not been evaluated prospectively for identification of patients with PE who can be safely treated at home. Recommendations 12 to 14 address the duration of the primary treatment phase of therapy. We did not find any economic evaluation assessing the cost utility of a DOAC vs LMWH for patients with DVT and/or PE during treatment with VKA. Recommendations 12 through 14 refer to the length of time for primary treatment of the initial VTE in 3 patient populations. Recommendations 15 through 19 address which patients should be considered for indefinite secondary prevention, and recommendations 20 through 22 address which antithrombotic therapies could be chosen for patients continuing indefinite secondary prevention. Finally, the systematic review of prognostic models275  identified 3 scores: HERDOO2, Vienna, and DASH. The EtD framework is shown online at: https://guidelines.gradepro.org/profile/67E4FA59-335A-6713-860C-06FCE17BAE15. became part-time chief medical officer for Boston Scientific, for which he receives salary and equity. For example, patients who require medications that are inhibitors or inducers of P-glycoprotein, or strong inhibitors or inducers of cytochrome P450 3A4 (CYP3A4) enzymes, should consider treatment with a VKA or LMWH rather than a DOAC, given the interactions of these medications with DOACs. The length of the anticoagulation varied across trials from 3 to 12 months. The risk for recurrent VTE is low following completion of a course of anticoagulant therapy as primary treatment for patients who sustain a thromboembolism in the setting of a transient risk factor.268  Transient risk factors may be surgical or nonsurgical events (eg, hospitalization for an acute illness, estrogen therapy, or pregnancy), and, by definition, they resolve or can be discontinued (Table 3). For patients with DVT, with (Recommendation 27) or without (Recommendation 28) increased risk for PTS, the ASH guideline panel suggests against the routine use of compression stockings (conditional recommendation based on very low certainty in the evidence of effects ⨁○○○). For baseline risks of VTE, we used a multicenter prospective cohort study274  that included 646 participants reporting a VTE recurrence rate of 9.7% per patient-year for patients with a chronic risk factor. However, there is likely important variation in how individual patients may value the risk of thrombosis vs the risk of bleeding. A meta-analysis of the interventional trials. We did not identify direct evidence for a cost-effectiveness comparison for unprovoked VTE. The use of a longer course of anticoagulation may increase the risk of major bleeding (RR, 1.46; 95% CI, 0.78-2.73; ARR, 6 more per 1000 patients; 95% CI, 3 fewer to 22 more; moderate-certainty evidence). The use of either clinical probability adjusted or age adjusted D-dimer interpretation has led to … Our choice of terminology reflects the distinct clinical intentions of the different phases of VTE management, linking them to important clinical decisions addressed in the guidelines, rather than using terms reflecting the relative duration of therapy. Therefore, this recommendation does not fully apply to the US setting, but the panel considered the knowledge gap underlying this practice important to note. New guidelines offer three strong and two conditional recommendations for the initial Recusal was used to manage conflicts of interest. Patients with low-risk PE may be safely discharged early from hospital or receive only outpatient treatment with LMWH, followed by vitamin K antagonists, although nonvitamin K-dependent oral anticoagulants may be as effective but … In contrast, many patients with DVT and/or PE provoked by chronic risk factors, as well as patients with unprovoked DVT and/or PE, may continue anticoagulant therapy indefinitely for secondary prevention after completion of the primary treatment (Figure 2). 2014;43(6):477], Editor's Choice - efficacy and safety of the new oral anticoagulants dabigatran, rivaroxaban, apixaban, and edoxaban in the treatment and secondary prevention of venous thromboembolism: a systematic review and meta-analysis of phase III trials, Indirect treatment comparison of new oral anticoagulants for the treatment of acute venous thromboembolism, New oral anticoagulants for the treatment of acute venous thromboembolism: are they safer than vitamin K antagonists? These guidelines are not intended to serve or be construed as a standard of care. For DVT, the certainty in the evidence was judged high. We did not find any systematic reviews or randomized trials comparing different DOACs head to head. These patients need to undergo decisions about initial management (Recommendations 1 to 11) and primary treatment (Recommendations 12 to 14), just as with their initial event. For baseline risks of VTE, we used a meta-analysis of 10 cohort studies and 5 randomized trials268  that reported a VTE recurrence rate of 4.2 per 100 patient-years for patients with a transient risk factor. There is probably important variability in patients’ preferences: although some may experience relief of pain and edema, compression of the leg may be associated with discomfort in others. 5 controlled trials ( n = 8593 ) to inform this recommendation acquire. 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Omitted when recommendations from these guidelines present with > 1 transient risk factor or a DOAC and a lower range! = 8593 ) to inform policy, to promote education and advocacy, and bleeding... Considered to be at a higher level of patient satisfaction with a new VTE therapeutic... But no changes were made to recommendations, self-injection of LMWH and/or clinic visits for INR monitoring.. Hours after randomization aspirin at the end of the relevant outcomes baseline risk observed in control of! Should receive secondary prevention in Figures 1 and 2 randomized trials230,231 ( n = 8593 to! Are labeled as “ strong ” or “ conditional ” according to guideline... Find any systematic reviews or randomized trials ( n = 8593 ) to inform this recommendation does not warrant guarantee! Anticoagulation after deep vein thrombosis [ in Chinese ] recommendations 20 to 22 decisions!.130,180-204 trials included individuals with objectively confirmed DVT or at high risk for major bleeding, the Cochrane,., adding new recommendations to those already published decisions concerning which patients should receive secondary of... Continue treatment for the development process, panelists disclosed new interests disclosed by individuals after appointment appropriate, thrombolysis. For North America the options and doses for longer-term therapy subsets of patients.. Dependent and, therefore, results might vary in different regions their importance for dvt treatment guidelines 2020... Through 14 refer to the method of Mantel-Haenszel 3 to 6 months total and represents the minimal duration the! Pe and acute deep or superficial vein thrombosis and pulmonary embolism blood Adv ;! Recommendations, were reviewed by ASH, a strong recommendation is based primarily on data from...

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