136 - Major Recommendations from the 2021 CHEST Anticoagulation for VTE Disease Guideline Updates

HelixTalk - Rosalind Franklin University's College of Pharmacy Podcast

Sean P. Kane, PharmD, BCPS

Health & Fitness, Medications, Rosalindfranklin, Rfums, Pharmacy, Pharmd, Pharmacist, Medicine, Drugs

5 • 644 Ratings

🗓️ 14 September 2021

⏱️ 39 minutes

🔗️ Recording | iTunes | RSS

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Summary

In this episode, we discuss the recently published major updates in the 9th edition of the anticoagulation guidelines from CHEST. These new recommendations range from initiation of therapy, secondary prevention, and management of post-thrombotic syndrome.

Key Concepts

Among patients with cancer-associated VTE, DOACs are preferred over low molecular weight heparins (LMWH) EXCEPT in patients with GI cancers. The preferred anticoagulant in those with GI cancers is either LMWH or apixaban.
Among patients with antiphospholipid antibody syndrome, warfarin (INR goal 2-3) is preferred over DOAC therapy.
In the extended phase of treatment (secondary prevention after 3 months of treatment), lower anticoagulant doses should be used (such as apixaban 2.5 mg BID or rivaroxaban 10 mg daily).
In patients with a DVT, IVC filters should only be used when anticoagulation therapy is contraindicated. IVC filters reduce the risk of PE but do not alter the risk of DVT extension or future DVTs.
Compression stockings are not recommended for prevention of post-thrombotic syndrome nor for recurrent DVT prevention.

Transcript

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0:00.0	Welcome to Helix Talk, an educational podcast for healthcare students and providers covering real-life clinical pearls, professional pharmacy topics, and drug therapy discussions.
0:11.0	This podcast is provided by pharmacists and faculty members at Rosal Franklin University College of Pharmacy.
0:17.0	This podcast contains general information for educational purposes only. This is not
0:22.0	professional advice and should not be used in lieu of obtaining advice from a qualified
0:26.0	health care provider. And now on to the show. Welcome to Helix Talk episode 136. I'm your
0:34.5	co-host Dr. Kane. And I'm Dr. Patel. And the topic of today's podcast is major
0:39.9	recommendations from the 2021 chest anticoagulation for VTE disease guidelines. I am so excited
0:48.4	that we're going to discuss this second update to the 9th edition. The 9th edition was originally published in 2012.
0:57.3	They did their first update to that guideline in 2016.
1:01.1	And so just recently, online-only publication made available in July, end of July of this year,
1:08.2	was their second update to this 9th edition. And Dr. Kane, you know, you and I both
1:13.9	work with anticoag patients, you know, in different capacities, but, you know, you see your
1:18.6	inpatient anticoag issues and I see my outpatient related anticoag issues. So this topic was very
1:24.2	pertinent and interesting to both of us, and I'm excited to talk about that.
1:28.3	For sure.
1:28.8	And, you know, just for the audience's benefit, we do have a link to the preprint of the executive summary of these guideline updates at our website.
1:37.0	So go to helixotoc.com episode 136.
1:40.2	What you'll see in that document is 17 PICO style questions.
1:44.9	So PICO stands for patient intervention comparators and outcomes.
1:48.4	It's just the format that they're using.
1:50.3	And they basically have 29 recommendations out of those 17 PICO questions.
1:55.0	Four of those are completely new.
	...

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