What are the key recommendations of the ACCP guidelines for antithrombotic thrombolytic therapy?

Updated: Jun 06, 2019
  • Author: Daniel R Ouellette, MD, FCCP; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Answer

The ACCP guidelines for antithrombotic and thrombolytic therapy are summarized as follows [5] :

  • Thrombolytic therapy should be used in patients with acute PE associated with hypotension (systolic BP < 90 mm Hg), who do not have a high bleeding risk (grade 2C).
  • Thrombolytic therapy is suggested in select patients with acute PE not associated with hypotension and with a low bleeding risk whose initial clinical presentation or clinical course after starting anticoagulation suggests a high risk of developing hypotension (grade 2C).
  • Assessment of PE severity, prognosis, and risk of bleeding dictates whether thrombolytic therapy should be started. Thrombolytic therapy is not recommended for most patients with acute PE not associated with hypotension (grade 1C).
  • All patients with unprovoked PE receive 3 months of treatment with anticoagulation rather than a shorter duration of treatment, and they have an assessment of the risk-to-benefit ratio of extended therapy at the end of 3 months (grade 1B).
  • Patients with a first episode of VTE and with a low or moderate risk of bleeding should have extended anticoagulant therapy (grade 2B). Patients with a first episode of VTE who have a high bleeding risk should have therapy limited to 3 months (grade 1B). In patients with a second unprovoked episode of VTE and low or moderate risk of bleeding, extended anticoagulant therapy is recommended (grades 1B and 2B, respectively). In patients with a second episode of VTE and a high risk of bleeding, 3 months of anticoagulation is preferred rather than extended anticoagulation (grade 2B).
  • Patients who have PE and preexisting irreversible risk factors, such as deficiency of antithrombin III, proteins S and C, factor V Leiden mutation, or the presence of antiphospholipid antibodies, should be placed on long-term anticoagulation.

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