Sandbox Rim

2012 Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (DO NOT EDIT)

Long-term Treatment of Patients With PE

Class I

"1. In patients with PE who are treated with VKA, we recommend a therapeutic INR range of 2.0 to 3.0 (target INR of 2.5) over a lower (INR < 2) or higher (INR 3.0-5.0) range for all treatment durations. (Level of Evidence: B)"

Class II

"1. In patients with PE and active cancer, if there is a high bleeding risk, we suggest extended anticoagulant therapy. (Level of Evidence: B)"

"2. In patients with PE and no cancer, we suggest VKA therapy over LMWH for long-term therapy (Level of Evidence: C). For patients with PE and no cancer who are not treated with VKA therapy, we suggest LMWH over dabigatran or rivaroxaban for long-term therapy. (Level of Evidence: C)"

"3. In patients with PE and cancer, we suggest LMWH over VKA therapy (Level of Evidence: B). In patients with PE and cancer who are not treated with LMWH, we suggest VKA over dabigatran or rivaroxaban for long-term therapy (Level of Evidence: C). "

6.4. In patients with PE and active cancer, if there is a low or moderate bleeding risk, we recommend extended anticoagulant therapy over 3 months of therapy (Grade 1B).

Patients Undergoing General, GI, Urological, Gynecologic, Bariatric, Vascular, Plastic, or Reconstructive Surgery

Class I

"1. For high-VTE-risk patients undergoing abdominal or pelvic surgery for cancer who are not otherwise at high risk for major bleeding complications, we recommend extended-duration pharmacologic prophylaxis (4 weeks) with LMWH over limited-duration prophylaxis. (Level of Evidence: B)"

Patients With Cancer in the Outpatient Setting

Class I

"1. In outpatients with cancer who have no additional risk factors for VTE, we recommend against the prophylactic use of VKAs. (Level of Evidence: B)"

4.2.1. In outpatients with cancer who have no additional risk factors for VTE, we suggest against routine prophylaxis with LMWH or LDUH (Grade 2B).

4.2.2. In outpatients with solid tumors who have additional risk factors for VTE and who are at low risk of bleeding, we suggest prophylactic-dose LMWH or LDUH over no prophylaxis (Grade 2B).

4.4. In outpatients with cancer and indwelling central venous catheters, we suggest against routine prophylaxis with LMWH or LDUH (Grade 2B) and suggest against the prophylactic use of VKAs (Grade 2C).