New International Guidelines Highlight Evidence-Based Recommendations to Prevent Venous Thromboembolism (VTE) - a Major Global Health Problem

The newly released version of the International Consensus Statement on Prevention and Treatment of Venous thromboembolism (VTE), one of the leading expert consensus document specifically dedicated to the prevention and treatment of VTE, was presented at the 22nd Congress of the International Union of Angiology, Lisbon, Portugal.

"These international guidelines provide recommendations guided by the rigorous review of clinical evidence by a large panel of international experts. These evidence-based guidelines provide updated recommendations on appropriate therapies and medical strategies to use with the different categories of patients at risk for VTE" says Pr. Andrew Nicolaides, Emeritus Professor, Imperial College, London, UK, and chairman of the editorial committee of the Guidelines.

VTE is now recognised to be a major global healthcare problem. The annual incidence of VTE in Europe and North America is approximately 160 per 100 000 for DVT, 20 per 100 000 for symptomatic non-fatal PE and an occurrence of fatal PE of 50 per 100 000.

Key highlights of those 2006 guidelines are the following:

- An emphasis is placed on preventing thrombosis in both medical and surgical patients. Medical patients contribute to the majority of the disease burden. Fatal PE is the leading cause of sudden death in hospitalised medical patients and it is estimated that as many as 1 of 20 of them may suffer a fatal PE in the absence of appropriate VTE prophylaxis.

- There is a strong recommendation that "All acutely ill medical patients should be routinely assessed for risk of VTE and considered for appropriate thromboprophylaxis".

- Emphasis is placed on appropriate prophylaxis, in terms of selection of agents and the duration of their use. Prolonged prophylaxis for up to 4-6 weeks is needed for some patients.

- As an alternative when pharmacological prophylaxis is contraindicated, mechanical methods such as intermittent pneumatic compression and graduated compression stockings are recommended to prevent deep vein thrombosis.

- Cancer patients are particularly at risk for VTE. Thrombosis is the second leading cause of death in patients with known cancer. For cancer patients, both advancing disease and surgical or medical anticancer treatments are known to increase the risk of thrombosis. It is therefore critical to ensure that when patients are at high risk for thrombosis they receive appropriate prophylaxis.

- The different therapeutic options recommended in the guidelines are selected based on the availability of specific clinical evidence in each clinical situation, for each method of prevention. Low molecular weight heparins (LMWHs) remain the main stay for prevention and treatment of VTE," the choice of LMWH should reflect the level of clinical evidence and the approval of the regulatory authorities for each indication."

"VTE is a major health problem and a vital patient safety issue. It is a preventable condition in the vast majority of patients at risk when appropriate prophylaxis is employed" stresses Dr Ajay Kakkar, Head of the Centre for Surgical Sciences at Barts and the London, Queen Mary's School of Medicine and Dentistry, and the Thrombosis Research Institute, London, UK, co-chairman of

"The implementation of strategies to routinely assess the risk of VTE is an important goal, and will contribute to preventing this disease. The IUA remains committed to the wide distribution of the new consensus guidelines and their implementation" said Professor Jawed Fareed, Director of the Haemostasis and Thrombosis Research Laboratories at Loyola University, Chicago, USA,

Background

About VTE - VTE arises when a blood clot, or thrombus, forms in a vein and blocks the blood vessel. VTE encompasses deep vein thrombosis (DVT) and pulmonary embolism (PE). PE is a life-threatening complication and occurs when a blood clot detaches from the vessel, escapes into the circulation and becomes lodged in the lungs. A triad of factors predispose a patient to VTE: venous stasis, alterations in blood constituents and changes in the surface of vessels. At least two factors need to co-exist for VTE to occur. Principal clinical predisposing influences are immobilisation, trauma, surgery, infection and the post-partum period. Other predisposing influences are age, obesity, and cancer; previous history of venous thrombosis, varicose veins, dehydration and

About the IUA - The International Union of Angiology is a society for vascular medicine, vascular surgery and endovascular interventions. Founded in 1950, the IUA gathers now experts from 71 different countries. It aims to stimulate, at an international level, scientific knowledge in all aspects of angiology by encouraging both basic research and clinical studies. International conferences are held every two years.

About the guidelines - The guidelines present the evidence in a concise format and attempt to indicate not only the magnitude of the effect of different prophylactic regimens but also the quality of the studies. Information on safety (clinically relevant bleeding and others adverse effects) is also provided. When randomised controlled studies are not available, the lack of data is stated and recommendations for the design of appropriate studies are made.

The system of grades used by the guidelines is consistent with the international high standard:

Grade A recommendations are based on Level 1 evidence from randomised controlled trials with consistent results (e.g. in systematic reviews), which are directly applicable to the target population. Single randomised controlled trials have not been accepted as Level 1 even when they were of a high quality and methodologically sound, and have been classified as grade B.

Grade B recommendations are based on Level 1 evidence from randomised controlled trials with less consistent results, limited power, or other methodological problems, which are directly applicable to the target population. Grade B recommendations are also based on Level 1 evidence from randomised controlled trials extrapolated from a different group of patients to the target population.

Grade C recommendations are based on Level 2 evidence from well-conducted observational studies with consistent results, directly applicable to the target population.

The information is completed by the inclusion of the safety data from each trial (clinically relevant bleeding and other adverse effects).

The guidelines have just been published in International Angiology, the official journal of the IUA: Nicolaides AN, Fareed J, Kakkar AK, Breddin HK, Goldhaber SZ, Hull R, et al. Prevention and treatment of venous thromboembolism. International Consensus Statement (Guidelines according to scientific evidence). Int Angiol 2006 Jun;25(2):101-61.

SOURCE: The International Union of Angiology

CONTACT: Dr. Evi Klodicki,

Co-chair Scientific Committee, IUA,

+44-776570-3329

--Distributed by AsiaNet ( www.asianetnews.net )--

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