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clot in deep vein

December 6, 2021 - In November 2021, the American College of Chest Physicians (ACCP) published updates to their venous thromboembolism (VTE) treatment guidelines; the last update was in 2016. Most of the recommendations are consistent with past guidance and widely recognized, but the highlights below may not be as well known.

  • Distal (calf) DVTs - many of these DVTs can be followed with weekly ultrasounds for 2 weeks. If the clot does not extend, anticoagulation is not recommended. See treatment of distal DVTs for more.
  • Subsegmental PE - subsegmental PEs are small emboli in the periphery of the lungs. Patients at low risk for recurrent VTE and negative lower extremity ultrasound do not require anticoagulation. See subsegmental PE for more.
  • Triple-positive antiphospholipid antibody (APA) syndrome - warfarin is preferred over direct-acting oral anticoagulants. This guidance is consistent with several recent studies that have found rivaroxaban to be inferior to warfarin in these patients. See APA syndrome treatment for more.
  • Provoked vs unprovoked VTE categories - perhaps the most intriguing part of the update was the addition of a new category for VTE provoking risk factors. The guidelines state that when deciding on long-term anticoagulation (beyond 3 months), patients should be divided into 3 groups - VTE provoked by a major transient risk factor, VTE provoked by a minor transient risk factor, or unprovoked VTE. Chronic anticoagulation is not recommended for the major or minor transient risk factor groups. This is the first guidance we've seen that has defined a minor provoking risk factor group. See ACCP extended anticoagulation recommendations for group definitions.


Deep vein thrombosis

Pulmonary embolism

Periprocedural antithrombotic recommendations