Skip to main content
Log in

The 2016 American College of Chest Physicians treatment guidelines for venous thromboembolism: a review and critical appraisal

  • POINTS OF VIEW
  • Published:
Internal and Emergency Medicine Aims and scope Submit manuscript

Abstract

The American College of Chest Physicians recently updated their practice guidelines for the treatment of patients with venous thromboembolism, comprising deep vein thrombosis and pulmonary embolism. The 2016 guidelines represent the tenth iteration of these guidelines, which are widely used, and are considered as the reference standard for practice guidelines related to venous thromboembolism. The objectives of this review are to highlight the key recommendations that are new in these guidelines, to address recommendations that may be considered controversial, and to touch on areas of ongoing research that may better inform some of these recommendations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Hirsh J, Hull RD (1986) Treatment of venous thromboembolism. Chest 89(5 Suppl):426S–433S

    Article  CAS  PubMed  Google Scholar 

  2. Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H et al (2016) Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest 149(2):315–352

    Article  PubMed  Google Scholar 

  3. Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ et al (2012) Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 141(2 Suppl):e419S–e494S

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Castellucci LA, Cameron C, Le Gal G, Rodger MA, Coyle D, Wells PS et al (2014) Clinical and safety outcomes associated with treatment of acute venous thromboembolism: a systematic review and meta-analysis. JAMA 312(11):1122–1135

    Article  CAS  PubMed  Google Scholar 

  5. Buller HR (2014) Edoxaban versus warfarin for venous thromboembolism. N Engl J Med 370(1):80–81

    Article  PubMed  Google Scholar 

  6. Dentali F, Di Minno MN, Gianni M, Ambrosino P, Squizzato A, Ageno W (2015) Non-vitamin K oral anticoagulants in patients with pulmonary embolism: a systematic review and meta-analysis of the literature. Intern Emerg Med 10(4):507–514

    Article  PubMed  Google Scholar 

  7. Kahn SR, Shapiro S, Wells PS, Rodger MA, Kovacs MJ, Anderson DR et al (2014) Compression stockings to prevent post-thrombotic syndrome: a randomised placebo-controlled trial. Lancet 383(9920):880–888

    Article  PubMed  Google Scholar 

  8. Enden T, Haig Y, Klow NE, Slagsvold CE, Sandvik L, Ghanima W et al (2012) 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 379(9810):31–38

    Article  PubMed  Google Scholar 

  9. Lee AY, Kamphuisen PW, Meyer G, Bauersachs R, Janas MS, Jarner MF et al (2015) Tinzaparin vs warfarin for treatment of acute venous thromboembolism in patients with active cancer: a randomized clinical trial. JAMA 314(7):677–686

    Article  CAS  PubMed  Google Scholar 

  10. Baglin T, Bauer K, Douketis J, Buller H, Srivastava A, Johnson G et al (2012) Duration of anticoagulant therapy after a first episode of an unprovoked pulmonary embolus or deep vein thrombosis: guidance from the SSC of the ISTH. J Thromb Haemost 10(4):698–702

    Article  CAS  PubMed  Google Scholar 

  11. Tosetto A, Iorio A, Marcucci M, Baglin T, Cushman M, Eichinger S et al (2012) Predicting disease recurrence in patients with previous unprovoked venous thromboembolism: a proposed prediction score (DASH). J Thromb Haemost 10(6):1019–1025

    Article  CAS  PubMed  Google Scholar 

  12. Rodger MA, Kahn SR, Wells PS, Anderson DA, Chagnon I, Le Gal G et al (2008) Identifying unprovoked thromboembolism patients at low risk for recurrence who can discontinue anticoagulant therapy. CMAJ 179(5):417–426

    Article  PubMed  PubMed Central  Google Scholar 

  13. Eichinger S, Heinze G, Jandeck LM, Kyrle PA (2010) Risk assessment of recurrence in patients with unprovoked deep vein thrombosis or pulmonary embolism: the Vienna prediction model. Circulation 121(14):1630–1636

    Article  PubMed  Google Scholar 

  14. Douketis J, Tosetto A, Marcucci M, Baglin T, Cushman M, Eichinger S et al (2010) Patient-level meta-analysis: effect of measurement timing, threshold, and patient age on ability of D-dimer testing to assess recurrence risk after unprovoked venous thromboembolism. Ann Intern Med 153(8):523–531

    Article  PubMed  Google Scholar 

  15. Palareti G, Cosmi B, Legnani C, Antonucci E, De Micheli V, Ghirarduzzi A et al (2014) D-dimer to guide the duration of anticoagulation in patients with venous thromboembolism: a management study. Blood 124(2):196–203

    Article  CAS  PubMed  Google Scholar 

  16. Kearon C, Ageno W, Cannegieter SC, Cosmi B, Geersing GJ, Kyrle PA et al (2016) Categorization of patients as having provoked or unprovoked venous thromboembolism: guidance from the SSC of ISTH. J Thromb Haemost 14(7):1480–1483

    Article  CAS  PubMed  Google Scholar 

  17. Baglin T, Douketis J, Tosetto A, Marcucci M, Cushman M, Kyrle P et al (2010) Does the clinical presentation and extent of venous thrombosis predict likelihood and type of recurrence? A patient-level meta-analysis. J Thromb Haemost 8(11):2436–2442

    Article  CAS  PubMed  Google Scholar 

  18. Brighton TA, Eikelboom JW, Mann K, Mister R, Gallus A, Ockelford P et al (2012) Low-dose aspirin for preventing recurrent venous thromboembolism. N Engl J Med 367(21):1979–1987

    Article  CAS  PubMed  Google Scholar 

  19. Becattini C, Agnelli G, Schenone A, Eichinger S, Bucherini E, Silingardi M et al (2012) Aspirin for preventing the recurrence of venous thromboembolism. N Engl J Med 366(21):1959–1967

    Article  CAS  PubMed  Google Scholar 

  20. Wiener RS, Schwartz LM, Woloshin S (2013) When a test is too good: how CT pulmonary angiograms find pulmonary emboli that do not need to be found. BMJ 347:f3368

    Article  PubMed  PubMed Central  Google Scholar 

  21. Carrier M, Righini M, Le Gal G (2012) Symptomatic subsegmental pulmonary embolism: what is the next step? J Thromb Haemost 10(8):1486–1490

    Article  CAS  PubMed  Google Scholar 

  22. Vedantham S, Goldhaber SZ, Kahn SR, Julian J, Magnuson E, Jaff MR et al (2013) Rationale and design of the ATTRACT Study: a multicenter randomized trial to evaluate pharmacomechanical catheter-directed thrombolysis for the prevention of postthrombotic syndrome in patients with proximal deep vein thrombosis. Am Heart J. 165(4):523–530

    Article  PubMed  PubMed Central  Google Scholar 

  23. Vedantham S, Kahn SR, Goldhaber SZ, Comerota AJ, Parpia S, Meleth S et al (2016) Endovascular therapy for advanced post-thrombotic syndrome: proceedings from a multidisciplinary consensus panel. Vasc Med 21(4):400–407

    Article  PubMed  PubMed Central  Google Scholar 

  24. Meyer G, Vicaut E, Danays T, Agnelli G, Becattini C, Beyer-Westendorf J et al (2014) Fibrinolysis for patients with intermediate-risk pulmonary embolism. N Engl J Med 370(15):1402–1411

    Article  CAS  PubMed  Google Scholar 

  25. Kline JA, Nordenholz KE, Courtney DM, Kabrhel C, Jones AE, Rondina MT et al (2014) Treatment of submassive pulmonary embolism with tenecteplase or placebo: cardiopulmonary outcomes at 3 months: multicenter double-blind, placebo-controlled randomized trial. J Thromb Haemost 12(4):459–468

    Article  CAS  PubMed  Google Scholar 

  26. Sharifi M, Bay C, Skrocki L, Rahimi F, Mehdipour M, Investigators M (2013) Moderate pulmonary embolism treated with thrombolysis (from the “MOPETT” Trial). Am J Cardiol 111(2):273–277

    Article  PubMed  Google Scholar 

  27. Ageno W, Beyer-Westendorf J, Garcia DA, Lazo-Langner A, McBane RD, Paciaroni M (2016) Guidance for the management of venous thrombosis in unusual sites. J Thromb Thrombolysis 41(1):129–143

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Liew A, Douketis J (2016) Portal vein thrombosis in patients with cirrhosis: underdiagnosis and undertreatment? Intern Emerg Med. doi:10.1007/s11739-016-1463-1

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to James Demetrios Douketis.

Ethics declarations

Conflict of interest

The author declares that he has no conflict of interest.

Statement of human and animal rights

This study did not involve human subjects.

Informed consent

This study has no involvement of research ethics boards.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Douketis, J.D. The 2016 American College of Chest Physicians treatment guidelines for venous thromboembolism: a review and critical appraisal. Intern Emerg Med 11, 1031–1035 (2016). https://doi.org/10.1007/s11739-016-1553-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11739-016-1553-0

Keywords

Navigation