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American Society of Hematology guidelines 2020 for secondary prevention of venous thromboembolism

  • 07

    By Katherine Kozlowski, Medical Author and Contributor to Vein News and www.VeinsVeinsVeins.com


    What are the initial management strategies for a patient who has been diagnosed with new venous thromboembolism, meaning deep vein thrombosis and/or embolism of a venous clot from the lower or upper extremities or pelvis to the lungs?  The American Society of Hematology provides guidelines in their 2020 document with the reference as shown below.  Here are the key initial features in this management algorithm which is divided into the Initial management phase, Primary Treatment phase, and Secondary Prevention phase:  

    The Initial Management Phase:   The initial management phase spans the first 5-21 days following the diagnosis of a new episode of venous thromboembolism.  It included issues regarding whether the patient can be treated at home or requires admission to the hospital for the following reasons.

       Use of thrombolytic therapy   

       Need for vena cava filter placement    

       Initial anticoagulation therapy   

    Primary Treatment phase:  The Primary treatment phase continues anticoagulation for 3-6 months total and represents the minimal duration of treatment for venous thromboembolism.  

    According to the American Society of Hematology guidelines, the period that follows the Primary Treatment phase is the Secondary Prevention phase.

    Secondary Prevention phase:  In the Secondary Prevention phase, decision-making concerns should address the need to continue treatment for secondary prevention of venous thromboembolism.  This means that the decision to continue is to address the need to anticoagulate to prevent another episode (secondary prevention) of venous thromboembolism. 

    The American Society of Hematology guidelines states that "typically, secondary prevention is continued indefinitely, although patients should be reevaluated on a regular basis to review the benefits of continued anticoagulation and the risks for continued anticoagulation.  


    Reference:  Thomas L. Ortel, Ignacio Neumann, Walter Ageno, Rebecca Beyth, Nathan P. Clark, Adam Cuker, Barbara A. Hutten, Michael R. Jaff, Veena Manja, Sam Schulman, Caitlin Thurston, Suresh Vedantham, Peter Verhamme, Daniel M. Witt, Ivan D. Florez, Ariel Izcovich, Robby Nieuwlaat, Stephanie Ross, Holger J. Schünemann, Wojtek Wiercioch, Yuan Zhang, Yuqing Zhang.  American College of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism.  Blood Adv 2020; 4(19): 4693-4736.