Anticoagulation management
Also known as: anticoagulant reversal · bridging · DOAC · warfarin
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American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism
American Society of Hematology (ASH) · 2020
The US hematology-society guideline on anticoagulant treatment of venous thromboembolism, organised around the phases of care: initial management, primary treatment, secondary prevention, and management of recurrent events. It addresses choice of anticoagulant class, treatment setting, and duration decisions.
- Contains 28 recommendations structured around initial management, primary treatment, secondary prevention and recurrent venous thromboembolism. source
- Addresses choice between direct oral anticoagulants and vitamin K antagonists, target INR range, home versus hospital treatment, and indefinite anticoagulation in recurrent unprovoked events. source
- Published in Blood Advances in 2020 (volume 4, pages 4693-4738), lead author Thomas L. Ortel. source
2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism
European Society of Cardiology (ESC), developed in collaboration with the European Respiratory Society (ERS) · 2019
The European reference guideline for acute pulmonary embolism, used here as the representative EU document for anticoagulation management. It covers diagnostic strategy, risk stratification, acute treatment including anticoagulation and reperfusion, and decisions about duration of anticoagulation after the acute phase.
- Covers diagnosis, risk assessment and acute and longer-term management of pulmonary embolism in adults. source
- Follows the earlier ESC pulmonary embolism guidelines of 2000, 2008 and 2014. source
- Developed jointly with the European Respiratory Society and published in the European Heart Journal in 2019; chaired by Stavros Konstantinides and Guy Meyer. source
US vs EU key differences
- Risk stratification differs: the ESC guideline formally classifies acute pulmonary embolism into four tiers — low, intermediate-low, intermediate-high and high risk — using PESI/simplified PESI together with right-ventricular dysfunction and troponin, whereas the ASH treatment guideline works from a simpler low-risk versus haemodynamically compromised distinction. source
- Tools for selecting home treatment differ: the ESC endorses the 12-item Hestia exclusion checklist or sPESI to choose candidates for early discharge, while ASH issues a conditional recommendation for home treatment of low-risk PE without endorsing a specific selection instrument. source
- Catheter-directed therapy is positioned differently: ASH suggests systemic thrombolysis over catheter-directed thrombolysis when reperfusion is needed for PE, whereas the ESC reserves catheter-directed treatment (Class IIa) for high-risk patients in whom systemic thrombolysis has failed or is contraindicated. source
- Scope differs: the ESC document covers diagnosis as well as treatment, including age-adjusted D-dimer thresholds (age x 10 µg/L above 50 years) and CT pulmonary angiography algorithms, while the ASH 2020 guideline addresses treatment of established DVT and PE only. source
- Both converge on DOACs as first-line anticoagulation over vitamin K antagonists, with the ESC giving this a Class I recommendation and excluding DOACs in antiphospholipid syndrome, severe renal impairment, pregnancy and lactation. source
What changed recently
- EU2014 → 20192019-08-31
The 2019 ESC/ERS update replaced the 2014 guideline, making direct oral anticoagulants the preferred agents for acute and long-term treatment of most pulmonary embolism patients, tightening the diagnostic algorithm around clinical probability and D-dimer (including a dedicated pathway for pregnancy), and adding structured follow-up for post-PE symptoms and chronic thromboembolic disease.
source ↗curation confidence 90%
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