Interpretation of the second update to the ninth edition of antithrombotic therapy guidelines for venous thromboembolism disease published by American College of Chest Physicians_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

DENG Yu ¹ , GAO Minglang ¹ ,  ZENG Guojun ² ,  GENG Qing ¹

1. Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, P. R. China;
2. Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding author：

ZENG Guojun, Email: benesun@qq.com; GENG Qing, Email: gengqingwhu@whu.edu.cn

Keywords：

Venous thromboembolism; deep venous thrombosis; pulmonary embolism; antithrombotic therapy; guideline interpretation

DOI：

10.7507/1007-4848.202201027

Video：

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Venous thromboembolism (VTE), comprising both deep vein thrombosis and pulmonary embolism, is a chronic illness that contributes significantly to the global burden of disease. The American College of Chest Physicians (ACCP) published the 9^th edition of antithrombotic treatment guidelines for VTE (AT9) in 2012, which was first updated in 2016. In October 2021, ACCP published the 2^nd update to AT9, which addressed 17 clinical questions related to VTE and presented 29 guidance statements in total. In this paper we interpreted the recommendations proposed in this update of the guidelines.

Citation： DENG Yu, GAO Minglang, ZENG Guojun, GENG Qing. Interpretation of the second update to the ninth edition of antithrombotic therapy guidelines for venous thromboembolism disease published by American College of Chest Physicians. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(3): 275-278. doi: 10.7507/1007-4848.202201027 Copy

1.	Khan F, Tritschler T, Kahn S R, et al. Venous thromboembolism. Lancet, 2021, 398(10294): 64-77.
2.	Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease. Chest, 2012, 141(2): e419S-e496S.
3.	Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease. Chest, 2016, 149(2): 315-352.
4.	Stevens SM, Woller SC, Kreuziger LB, et al. Antithrombotic therapy for VTE disease. Chest, 2021, 160(6): e545-e608.
5.	Winther-Larsen A, Hvas AM. Clinical impact of direct oral anticoagulant measuring in a real-life setting. Thromb Res, 2019, 175: 40-45.
6.	Wang TF, Li A, Garcia D. Managing thrombosis in cancer patients. Res Pract Thromb Haemost, 2018, 2(3): 429-438.
7.	Giustozzi M, Agnelli G, Del Toro-Cervera J, et al. Direct oral anticoagulants for the treatment of acute venous thromboembolism associated with cancer: A systematic review and meta-analysis. Thromb Haemost, 2020, 120(7): 1128-1136.
8.	Streiff MB, Holmstrom B, Angelini D, et al. NCCN guidelines insights: Cancer-associated venous thromboembolic disease, version 2. 2018. J Natl Compr Canc Netw, 2018, 16(11): 1289-1303.
9.	Kearon C, Ageno W, Cannegieter SC, et al. Subcommittees on control of anticoagulation, and predictive and diagnostic variables in thrombotic disease. Categorization of patients as having provoked or unprovoked venous thromboembolism: Guidance from the SSC of ISTH. J Thromb Haemost, 2016, 14(7): 1480-1483.
10.	Crowther M A, Cuker A. Reduced-intensity rivaroxaban for the prevention of recurrent venous thromboembolism. NEJM, 2017, 376(13): 1279-1280.
11.	Simes J, Becattini C, Agnelli G, et al. Aspirin for the prevention of recurrent venous thromboembolism: The INSPIRE collaboration. Circulation, 2014, 130(13): 1062-1071.
12.	Garcia D, Erkan D. Diagnosis and management of the antiphospholipid syndrome. NEJM, 2018, 378(21): 2010-2021.
13.	Ordi-Ros J, Sáez-Comet L, Pérez-Conesa M, et al. Rivaroxaban versus vitamin k antagonist in antiphospholipid syndrome: A randomized noninferiority Trial. Ann Inter Med, 2019, 171(10): 685-694.
14.	Pengo V, Denas G, Zoppellaro G, et al. Rivaroxaban vs. warfarin in high-risk patients with antiphospholipid syndrome. Blood, 2018, 132(13): 1365-1371.
15.	Di Nisio M, Wichers I, Middeldorp S. Treatment of lower extremity superficial thrombophlebitis. JAMA, 2018, 320(22): 2367-2368.
16.	Enden T, Haig Y, Kløw NE, et al. Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): A randomised controlled trial. Lancet, 2012, 379(9810): 31-38.
17.	Kearon C, Gu CS, Julian JA, et al. Pharmacomechanical catheter-directed thrombolysis in acute femoral-popliteal deep vein thrombosis: Analysis from a stratified randomized trial. Thromb Haemost, 2019, 119(4): 633-644.
18.	Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J, 2020, 41(4): 543-603.
19.	Mismetti P, Laporte S, Pellerin O, et al. Effect of a retrievable inferior vena cava filter plus anticoagulation vs. anticoagulation alone on risk of recurrent pulmonary embolism: A randomized clinical trial. JAMA, 2015, 313(16): 1627-1635.
20.	Duffett L, Carrier M. Inferior vena cava filters. J Thromb Haemost, 2017, 15(1): 3-12.
21.	Barco S, Lankeit M, Binder H, et al. Home treatment of patients with low-risk pulmonary embolism with the oral factor Ⅹa inhibitor rivaroxaban. Rationale and design of the HoT-PE Trial. Thromb Haemost, 2016, 116(1): 191-197.

1. Khan F, Tritschler T, Kahn S R, et al. Venous thromboembolism. Lancet, 2021, 398(10294): 64-77.
2. Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease. Chest, 2012, 141(2): e419S-e496S.
3. Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease. Chest, 2016, 149(2): 315-352.
4. Stevens SM, Woller SC, Kreuziger LB, et al. Antithrombotic therapy for VTE disease. Chest, 2021, 160(6): e545-e608.
5. Winther-Larsen A, Hvas AM. Clinical impact of direct oral anticoagulant measuring in a real-life setting. Thromb Res, 2019, 175: 40-45.
6. Wang TF, Li A, Garcia D. Managing thrombosis in cancer patients. Res Pract Thromb Haemost, 2018, 2(3): 429-438.
7. Giustozzi M, Agnelli G, Del Toro-Cervera J, et al. Direct oral anticoagulants for the treatment of acute venous thromboembolism associated with cancer: A systematic review and meta-analysis. Thromb Haemost, 2020, 120(7): 1128-1136.
8. Streiff MB, Holmstrom B, Angelini D, et al. NCCN guidelines insights: Cancer-associated venous thromboembolic disease, version 2. 2018. J Natl Compr Canc Netw, 2018, 16(11): 1289-1303.
9. Kearon C, Ageno W, Cannegieter SC, et al. Subcommittees on control of anticoagulation, and predictive and diagnostic variables in thrombotic disease. Categorization of patients as having provoked or unprovoked venous thromboembolism: Guidance from the SSC of ISTH. J Thromb Haemost, 2016, 14(7): 1480-1483.
10. Crowther M A, Cuker A. Reduced-intensity rivaroxaban for the prevention of recurrent venous thromboembolism. NEJM, 2017, 376(13): 1279-1280.
11. Simes J, Becattini C, Agnelli G, et al. Aspirin for the prevention of recurrent venous thromboembolism: The INSPIRE collaboration. Circulation, 2014, 130(13): 1062-1071.
12. Garcia D, Erkan D. Diagnosis and management of the antiphospholipid syndrome. NEJM, 2018, 378(21): 2010-2021.
13. Ordi-Ros J, Sáez-Comet L, Pérez-Conesa M, et al. Rivaroxaban versus vitamin k antagonist in antiphospholipid syndrome: A randomized noninferiority Trial. Ann Inter Med, 2019, 171(10): 685-694.
14. Pengo V, Denas G, Zoppellaro G, et al. Rivaroxaban vs. warfarin in high-risk patients with antiphospholipid syndrome. Blood, 2018, 132(13): 1365-1371.
15. Di Nisio M, Wichers I, Middeldorp S. Treatment of lower extremity superficial thrombophlebitis. JAMA, 2018, 320(22): 2367-2368.
16. Enden T, Haig Y, Kløw NE, et al. Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): A randomised controlled trial. Lancet, 2012, 379(9810): 31-38.
17. Kearon C, Gu CS, Julian JA, et al. Pharmacomechanical catheter-directed thrombolysis in acute femoral-popliteal deep vein thrombosis: Analysis from a stratified randomized trial. Thromb Haemost, 2019, 119(4): 633-644.
18. Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J, 2020, 41(4): 543-603.
19. Mismetti P, Laporte S, Pellerin O, et al. Effect of a retrievable inferior vena cava filter plus anticoagulation vs. anticoagulation alone on risk of recurrent pulmonary embolism: A randomized clinical trial. JAMA, 2015, 313(16): 1627-1635.
20. Duffett L, Carrier M. Inferior vena cava filters. J Thromb Haemost, 2017, 15(1): 3-12.
21. Barco S, Lankeit M, Binder H, et al. Home treatment of patients with low-risk pulmonary embolism with the oral factor Ⅹa inhibitor rivaroxaban. Rationale and design of the HoT-PE Trial. Thromb Haemost, 2016, 116(1): 191-197.

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Interpretation of the second update to the ninth edition of antithrombotic therapy guidelines for venous thromboembolism disease published by American College of Chest Physicians

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