Are there American College of Chest Physicians (CHEST) guidelines for thromboembolism?

From the Guidelines

Yes, the American College of Chest Physicians (CHEST) has guidelines for thromboembolism, which have been developed and published for almost 40 years 1.

Overview of CHEST Guidelines

• The guidelines are based on the patient, intervention, comparator, outcome (PICO) framework and contain guidance statements created using explicit methodology.
• The most recent guidelines include the 9th edition of the Antithrombotic Therapy and Prevention of Thrombosis (AT9) and two updates, published in 2016 and 2021, which address various aspects of antithrombotic therapy for venous thromboembolism (VTE) disease 1.

Key Recommendations

• The guidelines provide recommendations for the treatment of VTE, including the use of anticoagulation therapy, serial imaging, and interventional therapy.
• For example, in patients with acute isolated distal DVT of the leg, the guidelines suggest serial imaging of the deep veins for 2 weeks over anticoagulation in those without severe symptoms or risk factors for extension, and anticoagulation over serial imaging in those with severe symptoms or risk factors for extension 1.

Updates and Revisions

• The guidelines have undergone updates and revisions to reflect new evidence and advances in medical literature.
• A compendium and review of the CHEST guidelines from 2012 to 2021 has been published, which collects the current guidance statements into a single location for easier reference for clinicians and other readers 1.

Clinical Application

• The guidelines are intended to inform best clinical care of complex clinical conditions and use of therapies that carry significant risks.
• Clinicians should consult the guidelines and use their clinical judgment to make decisions about the treatment of VTE, taking into account the individual patient's needs and circumstances.

From the Research

American College of Chest Physicians (CHEST) Guidelines for Thromboembolism

• The American College of Chest Physicians (ACCP) has published guidelines for the treatment and prevention of venous thromboembolism (VTE) 2, 3, 4, 5, 6.
• The guidelines provide recommendations for the treatment of patients with deep vein thrombosis (DVT) and pulmonary embolism (PE), including the use of anticoagulant therapy, thrombolytic therapy, and inferior vena cava filter placement 2, 3, 4.
• The guidelines also provide recommendations for the prevention of VTE in patients undergoing major surgery, including the use of low-molecular-weight heparin (LMWH), low-dose unfractionated heparin (LDUH), and fondaparinux 5, 6.
• The ACCP guidelines are widely used and considered the reference standard for practice guidelines related to VTE 2.
• The guidelines are updated regularly, with new iterations providing updated recommendations based on the latest evidence 2, 4, 6.

Key Recommendations

• For patients with objectively confirmed DVT or PE, the guidelines recommend anticoagulant therapy with LMWH, UFH, or fondaparinux 4.
• For patients with a high clinical suspicion of DVT or PE, the guidelines recommend treatment with anticoagulants while awaiting the outcome of diagnostic tests 4.
• For patients undergoing major general surgery, the guidelines recommend thromboprophylaxis with LMWH, LDUH, or fondaparinux 5, 6.
• For patients undergoing elective hip or knee arthroplasty, the guidelines recommend one of the following three anticoagulant agents: LMWH, fondaparinux, or a vitamin K antagonist (VKA) 5, 6.