ASH Clinical News ACN_4.14_Full Issue_web | Page 133

The Guidelines Browse through the brief summaries below to get a sense of what to expect from all 10 of the ASH Clinical Practice Guidelines on VTE. Access the first six by visiting www.bloodadvances.org/VTE. Prophylaxis for Medical Patients Medical inpatients, long- term care residents, persons with minor injuries, and long-distance travelers are at increased risk of VTE, which can be fatal. Hospitalization for acute medical illness is an important opportunity for applying prevention efforts. These guidelines address methods to prevent VTE in hospitalized and non-hospitalized medical patients and long-distance travelers. Diagnosis Accurate diagnosis of VTE is important due to the morbidity and mortality associated with missed diagnoses and the potential side effects, patient inconvenience, and resource implications of anticoagulant treatment given for VTE. These guidelines are intended to support patients, clinicians, and health care professionals in VTE diagnosis. Diagnostic strategies were evaluated for pulmonary embolism (PE), deep vein thrombosis (DVT) of the lower and upper extremity, and recurrent VTE. Anticoagulation Therapy Clinicians confront numerous practical issues in optimizing the use of anticoagulants to treat VTE. Anticoagulant therapy is complex and associated with substantial benefits and risks. These guidelines focus on the optimal management of anticoagulant drugs for the prevention and treatment of VTE following the choice of an anticoagulant. Heparin-Induced Thrombocytopenia (HIT) HIT is a prothrombotic adverse drug reaction. One- third to one-half of cases of HIT are complicated by thrombosis, which may be limb- or life-threatening. Recommendations address screening of asymptomatic patients for HIT, diagnosis and initial management of patients with suspected HIT, treatment of acute HIT, and special situations in patients with acute HIT or a history of HIT, including cardiovascular surgery, percutaneous cardiovascular intervention (PCI), renal replacement therapy, and VTE prophylaxis. Pregnancy Pregnancy-associated VTE is a leading cause of maternal morbidity and mortality. The diagnosis, prevention, and treatment of pregnancy-associated VTE are particularly difficult because of the need to consider fetal, as well as maternal, well-being. These guidelines address these challenging issues.