Venous Thromboembolism Treatment Guidelines
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Video Transcription
0:00
Hello, my name is Stanislav Henkin, and I'm the Director of the Vascular Medicine Program at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire.
0:16
And today, I'm going to be discussing the venous thromboembolism treatment guidelines with you. I have no disclosures pertinent to this presentation.
0:26
So our learning objective today is quite simple. It is to select the best anticoagulant for initial management of acute venous thromboembolism,
0:34
including the drug, the dose, and the duration. And to achieve this objective, we will take a look at two guidelines today.
0:44
This is the antithrombotic therapy for VTE from the CHESS guideline and expert panel report, as well as the American Society of Hematology 2020 guidelines for the management
0:53
of venous thromboembolism, treatment of deep vein thrombosis, and pulmonary embolism. And I will provide you with both guidelines, as well as compare and contrast the guideline
1:03
recommendations for specific patient scenarios. When we talk about different guidelines, we will talk about the strength of recommendation
1:12
both from the guidelines as well as the certainty. And I will color code this for you. When the evidence is strong with high certainty, this will be in green.
1:24
When the evidence is weak or conditional with moderate certainty, this will be in yellow. And when there is no evidence or it is thought to be harmful with low certainty, the harm
1:35
will be in red and the certainty will be in orange. Now when we talk about venous thromboembolism, we have to break it down into several different time points.
1:48
We have to break it down into initial treatment, the primary treatment, and the secondary prevention.
1:53
First, when VTE or venous thromboembolism is diagnosed, the initial treatment is counted
1:57
as the first 21 days, and this is when usually there is a lead-in with a certain anticoagulant to get to steady state.
Video Summary
In this video, Dr. Henkin discusses the treatment guidelines for venous thromboembolism (VTE). He starts by explaining the different time points in VTE treatment, including initial treatment, primary treatment, and secondary prevention. Dr. Henkin then goes on to discuss specific patient scenarios and the recommended anticoagulant options. For a low-risk pulmonary embolism, outpatient treatment is sufficient if the patient has access to medication and follow-up care. The use of direct oral anticoagulants (DOACs) is recommended over vitamin K antagonists in most cases. In cases of isolated distal deep vein thrombosis (DVT), serial imaging may be considered instead of anticoagulation. However, if the DVT extends into proximal veins, anticoagulation is recommended. The use of systemic thrombolysis is recommended for massive pulmonary embolism, with catheter or direct-assisted therapies considered if there is high bleeding risk or failed systemic thrombolysis. Dr. Henkin also discusses the duration of anticoagulation, with the primary phase lasting 3-6 months and the secondary prevention phase lasting 3-6 months. He concludes the video by summarizing the appropriate dosing of anticoagulants for different phases of treatment.
Keywords
venous thromboembolism
treatment guidelines
anticoagulant options
pulmonary embolism
direct oral anticoagulants
distal deep vein thrombosis
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