From the Guidelines
The CHEST guidelines are evidence-based clinical practice recommendations developed by the American College of Chest Physicians to guide healthcare providers in managing various pulmonary, critical care, and sleep medicine conditions, with a focus on antithrombotic therapy, venous thromboembolism (VTE) prevention and treatment, pulmonary arterial hypertension, cough, asthma, COPD, lung cancer, and critical care medicine, as outlined in the most recent guideline update 1. The guidelines cover a wide range of topics and are regularly updated based on new evidence, with the goal of providing practical tools that balance benefits against risks while considering patient values and preferences.
- The guidelines recommend risk assessment followed by appropriate prophylaxis such as low molecular weight heparin (enoxaparin 40mg daily), unfractionated heparin (5000 units three times daily), or fondaparinux (2.5mg daily) for high-risk patients, as stated in the executive summary of the antithrombotic therapy for VTE disease guideline update 1.
- For VTE treatment, they recommend initial anticoagulation with direct oral anticoagulants (DOACs) like apixaban (10mg twice daily for 7 days, then 5mg twice daily) over vitamin K antagonists for most patients without cancer, as supported by the evidence-based clinical practice guidelines for the prevention and management of postoperative atrial fibrillation after cardiac surgery 1. The guidelines are designed to be global in coverage, with international expert panels and widespread internet access, making them a valuable resource for healthcare providers around the world, as highlighted in the point-counterpoint discussion on the global coverage of CHEST guidelines 1. Key aspects of the guidelines include:
- Regular updates based on new evidence
- Focus on patient values and preferences
- Detailed algorithms and decision pathways for complex clinical scenarios
- Global coverage and accessibility
- Emphasis on antithrombotic therapy, VTE prevention and treatment, and other critical topics in pulmonary, critical care, and sleep medicine.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Overview of CHEST Guidelines
The American College of Chest Physicians (CHEST) guidelines provide evidence-based recommendations for the prevention and treatment of venous thromboembolism (VTE). The guidelines are based on a thorough review of the literature and are intended to assist healthcare professionals in making informed decisions about the care of patients with VTE.
Treatment of Venous Thromboembolism
- For patients with objectively confirmed deep vein thrombosis (DVT) or pulmonary embolism (PE), anticoagulant therapy with subcutaneous low-molecular-weight heparin (LMWH), monitored IV, or subcutaneous unfractionated heparin (UFH) is recommended 2.
- For patients with a high clinical suspicion of DVT or PE, treatment with anticoagulants while awaiting the outcome of diagnostic tests is recommended 2.
- For patients with confirmed PE, early evaluation of the risks and benefits of thrombolytic therapy is recommended, and short-course thrombolytic therapy is recommended for those with hemodynamic compromise 2.
Prevention of Venous Thromboembolism
- Every hospital should develop a formal strategy to address the prevention of VTE 3.
- Aspirin alone should not be used as thromboprophylaxis for any patient group 4, 3.
- Mechanical methods of thromboprophylaxis should be used primarily for patients at high bleeding risk or as an adjunct to anticoagulant thromboprophylaxis 3.
- For patients undergoing major general surgery, thromboprophylaxis with LMWH, low-dose unfractionated heparin (LDUH), or fondaparinux is recommended 4, 3.
Special Considerations
- For patients with cancer, low molecular weight heparins are the preferred option for anticoagulation, but new anticoagulants such as apixaban may also be considered 5, 6.
- For patients undergoing elective hip or knee arthroplasty, one of the following three anticoagulant agents is recommended: LMWH, fondaparinux, or a vitamin K antagonist (VKA) 4, 3.
- For patients admitted to hospital with an acute medical illness, thromboprophylaxis with LMWH, LDUH, or fondaparinux is recommended 3.