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New In Coagulation
Thursday, July 10, 2008
New Thromboembolic Guidelines May Spark Controversy
Primary source:
Chest
Source reference:
Hirsh J, et al "Executive summary: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition)" CHEST 2008; 133: 71S-105S.
The 2008 guidelines contain 179 new recommendations, as well as new chapters, to deal with areas of care that have seen significant development since the 2004 guidelines were issued, according to Jack Ansell, M.D., chief of medicine at Lennox Hill Hospital in New York and a member of the panel that developed the guidelines.
They are published as a 22-chapter supplement to the June issue of CHEST and are available online.
The guidelines say there is now enough evidence to conclude that home tests of prothrombin time, using a small instrument similar to a glucometer, lead to outcomes as good as or better than those based on in-office blood tests.
"For suitable patients," Dr. Ansell said, "this is a valid way to manage warfarin therapy."
Warfarin is also the subject of a new chapter on how to manage patients taking the drug when they need invasive procedures. "This is a difficult and complex area," Dr. Ansell said.
Many of the new recommendations deal with the topical issue of deep vein thrombosis (DVT), he said, including one that suggests all hospitals should have or be developing institution-wide policies on DVT prevention.
For the general public, DVT has become associated with long-haul air travel, Dr. Ansell said. "It's a very unusual occurrence," he said, but there have been suggestions that aspirin or anti-coagulant medications should be used to prevent it.
Related Article(s):
• FDA Alters Warfarin Label to Reflect Gene Tests for Bleeding Risks
Donna Castellone
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