Pulmonary Vascular

Guidelines and Expert Panel Reports

NEW: Antithrombotic Therapy for VTE Disease (Published: February 2016)
This CHEST guideline update addresses new developments and ongoing controversies in the treatment of VTE.

Learn about all the changes to this guideline with these e-Learning modules and earn AMA PRA Category 1 Credits™ and MOC points.

Antithrombotic Therapy and Prevention of Thrombosis (9^th Edition), Published: February 2012
This CHEST guideline series presents recommendations for the prevention, diagnosis, and treatment of thrombosis, addressing a comprehensive list of clinical conditions, including medical, surgery, orthopedic surgery, atrial fibrillation, stroke, cardiovascular disease, pregnancy, and neonates and children.

• Executive Summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines

• Introduction to the Ninth Edition: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines

• Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines

• Patient Values and Preferences in Decision Making for Antithrombotic Therapy: A Systematic Review: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
  This article reviews the values and preferences of patients considering antithrombotic therapy.

• Parenteral Anticoagulants: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
  This article describes the pharmacology of approved parenteral anticoagulants.

• Oral Anticoagulant Therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
  This article summarizes the published literature concerning the pharmacokinetics and pharmacodynamics of oral anticoagulant drugs that are currently available for clinical use and other aspects related to their management.

• Antiplatelet Drugs: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
  This article describes the mechanisms of action, pharmacokinetics, and pharmacodynamics of aspirin, dipyridamole, cilostazol, the thienopyridines, and the glycoprotein IIb/IIIa antagonists.

• New Antithrombotic Drugs: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
  This article focuses on new antithrombotic drugs that are in or are entering phase 3 clinical testing.

• Evidence-Based Management of Anticoagulant Therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
  This CHEST guideline addresses guidance for many common anticoagulation-related management problems.

• Approach to Outcome Measurement in the Prevention of Thrombosis in Surgical and Medical Patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
  This article provides the rationale for the approach to making recommendations primarily used in four articles of the Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines: orthopedic surgery, nonorthopedic surgery, nonsurgical patients, and stroke.

• Prevention of VTE: Nonsurgical Patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
  This CHEST guideline addresses VTE prevention in hospitalized medical patients, outpatients with cancer, the chronically immobilized, long-distance travelers, and those with asymptomatic thrombophilia. An update to this guideline topic was published in 2016.

• Prevention of VTE: Nonorthopedic Surgical Patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
  This CHEST guideline addresses VTE prevention after explicitly weighing the trade-offs between the potential benefits and harms of alternative strategies for prophylaxis. 

• Prevention of VTE: Orthopedic Surgery Patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
  This CHEST guideline addresses optimal prophylaxis to reduce postoperative pulmonary embolism and DVT.

• Perioperative Management of Antithrombotic Therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
  This CHEST guideline addresses the management of patients who are receiving anticoagulant or antiplatelet therapy and require an elective surgery or procedure.

• Diagnosis of DVT: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
  This CHEST guideline addresses the identification of optimal strategies for the diagnosis of DVT in ambulatory adults.

• Antithrombotic Therapy for VTE Disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines

• Treatment and Prevention of Heparin-Induced Thrombocytopenia: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
  This CHEST guideline addresses diagnosis and management of heparin-induced thrombocytopenia (HIT).

• Antithrombotic Therapy for Atrial Fibrillation: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
  This CHEST guideline addresses antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios.

• Antithrombotic and Thrombolytic Therapy for Valvular Disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
  This CHEST guideline addresses the optimal balance of thrombotic and hemorrhagic risk.

• Antithrombotic and Thrombolytic Therapy for Ischemic Stroke: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
  This CHEST guideline addresses the use of antithrombotic therapy in patients with stroke or transient ischemic attack (TIA). 

• Primary and Secondary Prevention of Cardiovascular Disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
  This CHEST guideline addresses long-term administration of antithrombotic drugs designed for primary and secondary prevention of cardiovascular disease, including two new antiplatelet therapies.

• Antithrombotic Therapy in Peripheral Artery Disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
  This CHEST guideline addresses antithrombotic drug therapies for primary and secondary prevention of cardiovascular disease as well as for the relief of lower-extremity symptoms and critical ischemia in persons with peripheral artery disease (PAD).

• VTE, Thrombophilia, Antithrombotic Therapy, and Pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
  This CHEST guideline addresses the management of VTE and thrombophilia as well as the use of antithrombotic agents during pregnancy.

• Antithrombotic Therapy in Neonates and Children: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
  This CHEST guideline addresses optimal strategies for the management of thrombosis in neonates and children.

Pharmacologic Therapy for Pulmonary Arterial Hypertension in Adults (Published: August 2014)
This CHEST hybrid document aims to provide practical guidance to clinicians faced with common questions regarding the use of available pharmacotherapies for the treatment of patients with pulmonary arterial hypertension (PAH).

Clinician Tools and Materials

Podcasts
CHEST hosts a discussion with the authors upon release of a guideline, to add context and commentary to the issues and challenges facing clinicians.

Antithrombotic Therapy for VTE Disease: CHEST Guideline (February 2016)
Duration: 33 min
Moderator: Ian T. Nathanson, MD, FCCP, Section Editor, CHEST
Participants: Clive Kearon, MD, PhD; COL Lisa K. Moores, MC, USA, FCCP

Pulmonary Arterial Hypertension: New CHEST Guidelines and New CDC Report (August 2014)
Duration: 28 min
Moderator: D. Kyle Hogarth, MD, FCCP, Podcast Editor, CHEST
Participants: Terence K. Trow, MD, FCCP; Mary G. George, MD; Anna R. Hemnes, MD

Presentation Slides
CHEST develops slide sets to incorporate into educational presentations, for the purposes of disseminating and explaining guideline recommendations.

All slides are Copyright © 2016 American College of Chest Physicians. No part of this publication may be reproduced/used in any manner without permission from the publisher.

• Evidence-Based Management of Anticoagulant Therapy
  Recommendations for the general management of anticoagulant therapy. These slides address initiation, maintenance, dosing, drug interactions, bleeding, and organization of care, offering guidance for many common anticoagulation-related management problems. 

• Prevention of Venous Thromboembolism in Nonsurgical Patients
  Recommendations regarding the decisions in prophylaxis in nonsurgical patients. These slides take into consideration risk factors for both thrombosis and bleeding, clinical context, and patients’ values and preferences. Recommendations incorporate perspectives in bleeding disorders, critical care, preventive medicine, methodology, and cost effectiveness. 

• Prevention of Venous Thromboembolism in Nonorthopedic Surgical Patients
  Recommendations for optimal thromboprophylaxis in nonorthopedic surgical patients. The slides address the risks of venous thromboembolism and bleeding complications, as well as the values and preferences of individual patients.

• Prevention of Venous Thromboembolism in Orthopedic Surgery Patients
  Recommendations for the optimal strategies for thromboprophylaxis after major orthopedic surgery. Topics covered include pharmacologic and mechanical approaches to reduce patient-important outcomes, such as pulmonary embolism and symptomatic DVT.

• The Perioperative Management of Antithrombotic Therapy
  Recommendations to simplify patient management and minimize adverse clinical outcomes for perioperative antithrombotic management based on risk assessment for thromboembolism and bleeding.

• Diagnosis of DVT
  Recommendations for diagnosis of first DVT, including a combined use of pretest probability assessment, D-dimer, and ultrasound.

• Treatment and Prevention of Heparin-Induced Thrombocytopenia (February 2012)
  Recommendations regarding heparin-induced thrombocytopenia and the primary efficacy outcome measures of interest, including new thrombosis, limb amputation, and major bleeding and death due to thrombosis or bleeding.

• Antithrombotic Therapy in Atrial Fibrillation (February 2012)
  Recommendations regarding atrial fibrillation based on net clinical benefit for patients at varying levels of stroke risk and in a number of common clinical scenarios.

• Antithrombotic and Thrombolytic Therapy for Valves (February 2012)
  Recommendations based on the optimal balance of thrombotic and hemorrhagic risk for antithrombotic therapy in valvular disease. 

• Antithrombotic and Thrombolytic Therapy for Ischemic Stroke (February 2012)
  Recommendations for the use of antithrombotic therapy in patients with stroke or transient ischemic attack.

• The Primary and Secondary Prevention of Cardiovascular Disease (February 2012)
  Recommendations focusing on long-term administration of antithrombotic drugs designed for primary and secondary prevention of cardiovascular disease, including two new antiplatelet therapies (ticagrelor and prasugrel).

• Antithrombotic Therapy in Peripheral Artery Disease (February 2012)
  Recommendations regarding antithrombotic drug therapies for primary and secondary prevention of cardiovascular disease as well as for the relief of lower-extremity symptoms and critical ischemia in patients with peripheral arterial disease (PAD). The slide set highlights single antiplatelet therapy for primary and secondary prevention of cardiovascular events in most patients with asymptomatic PAD, symptomatic PAD, and asymptomatic carotid stenosis.

• Venous Thromboembolism, Thrombophilia, Antithrombotic Therapy, and Pregnancy (February 2012)
  Recommendations focusing on the management of venous thromboembolism and thrombophilia. It discusses the use of antithrombotic agents during pregnancy and the associated challenges because of the potential for both fetal and maternal complications.

• Antithrombotic Therapy in Neonates and Children (February 2012)
  Recommendations focusing on the monitoring to specific target ranges for both unfractionated and low-molecular-weight heparins in neonates and children. It acknowledges the ongoing need for dedicated clinical trials that demonstrate the differences in the pharmacokinetics, dose responses, and monitoring tests for anticoagulation therapy in children compared with adults.