title: Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report.
abstract: BACKGROUND
  We update recommendations on 12 topics that were in the 9th edition of these guidelines, and address 3 new topics.
  
  
  METHODS
  We generate strong (Grade 1) and weak (Grade 2) recommendations based on high- (Grade A), moderate- (Grade B), and low- (Grade C) quality evidence.
  
  
  RESULTS
  For VTE and no cancer, as long-term anticoagulant therapy, we suggest dabigatran (Grade 2B), rivaroxaban (Grade 2B), apixaban (Grade 2B), or edoxaban (Grade 2B) over vitamin K antagonist (VKA) therapy, and suggest VKA therapy over low-molecular-weight heparin (LMWH; Grade 2C). For VTE and cancer, we suggest LMWH over VKA (Grade 2B), dabigatran (Grade 2C), rivaroxaban (Grade 2C), apixaban (Grade 2C), or edoxaban (Grade 2C). We have not changed recommendations for who should stop anticoagulation at 3 months or receive extended therapy. For VTE treated with anticoagulants, we recommend against an inferior vena cava filter (Grade 1B). For DVT, we suggest not using compression stockings routinely to prevent PTS (Grade 2B). For subsegmental pulmonary embolism and no proximal DVT, we suggest clinical surveillance over anticoagulation with a low risk of recurrent VTE (Grade 2C), and anticoagulation over clinical surveillance with a high risk (Grade 2C). We suggest thrombolytic therapy for pulmonary embolism with hypotension (Grade 2B), and systemic therapy over catheter-directed thrombolysis (Grade 2C). For recurrent VTE on a non-LMWH anticoagulant, we suggest LMWH (Grade 2C); for recurrent VTE on LMWH, we suggest increasing the LMWH dose (Grade 2C).
  
  
  CONCLUSIONS
  Of 54 recommendations included in the 30 statements, 20 were strong and none was based on high-quality evidence, highlighting the need for further research.
authors: McMaster University, Hamilton, ON.
authors: Clive
authors: C
authors: Kearon
authors: McMaster University, Hamilton, ON; American University of Beirut, Beirut, Lebanon. Electronic address: ea32@aub.edu.lb.
authors: Elie A
authors: EA
authors: Akl
authors: CHEST, Glenview, IL.
authors: Joseph
authors: J
authors: Ornelas
authors: VA New Jersey Health Care System, Newark, NJ.
authors: Allen
authors: A
authors: Blaivas
authors: Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcala, Madrid, Spain.
authors: David
authors: D
authors: Jimenez
authors: University of Geneva, Geneva, Switzerland.
authors: Henri
authors: H
authors: Bounameaux
authors: Leiden University Medical Center, Leiden, Netherlands.
authors: Menno
authors: M
authors: Huisman
authors: Virginia Commonwealth University, Falls Church, VA.
authors: Christopher S
authors: CS
authors: King
authors: University of California, San Diego, CA.
authors: Timothy A
authors: TA
authors: Morris
authors: The Ohio State University, Columbus, OH.
authors: Namita
authors: N
authors: Sood
authors: Intermountain Medical Center and the University of Utah, Murray, UT.
authors: Scott M
authors: SM
authors: Stevens
authors: Harbor-UCLA Medical Center, Torrance, CA.
authors: Janine R E
authors: JRE
authors: Vintch
authors: The University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON.
authors: Philip
authors: P
authors: Wells
authors: Intermountain Medical Center and the University of Utah, Murray, UT.
authors: Scott C
authors: SC
authors: Woller
authors: Uniformed Services University of the Health Sciences, Bethesda, MD.
authors: Lisa
authors: L
authors: Moores
mesh_terms: D004334:Drug Administration Schedule; D019317:Evidence-Based Medicine / Q000592:standards*; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D019934:International Normalized Ratio; D012955:Societies, Medical; D020246:Venous Thrombosis / Q000097:blood / Q000188:drug therapy*
chemical_list: D005343:Fibrinolytic Agents
keywords: GRADE approach; antithrombotic therapy; evidence-based medicine; venous thromboembolism