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Venous Thromboembolism (VTE) Learning Zone

VTE management

Read time: 85 mins
Last updated:4th May 2023
Published:25th Feb 2022

Management of venous thromboembolism (VTE) includes risk assessment, prevention, initial and primary treatment, and secondary prevention.

  • Learn about assessing the risk of thrombosis and bleeding in patients with VTE
  • Understand the latest recommendations for management of VTE, guidance for anticoagulation treatment, and how to determine which patients are suitable for outpatient treatment
  • Join Professor Stavros Konstantinides to explore guidance on key aspects of risk assessment and VTE management

VTE management guidelines

Professor Stavros Konstantinides, Medical Director of the Center for Thrombosis and Hemostasis at Johannes Gutenberg University Mainz in Germany, provides an overview of key updated guideline recommendations in 2019–2021 and their impact on clinical practice.

Clinical practice guidelines for management of VTE include:

  • 2019 European Society of Cardiology (ESC)/European Respiratory Society (ERS) guidelines1
  • 2020 American Society of Hematology (ASH) guidelines2
  • 2020 National Institute for Health and Care Excellence (NICE) guidelines3
  • 2021 European Society for Vascular Surgery (ESVS) guidelines4
  • 2021 update of the American College of Chest Physicians (CHEST) clinical practice guidelines5

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VTE risk assessment and prognostic stratification

For optimal management of venous thromboembolism (VTE), it is essential to understand a patient’s risk of thrombosis and risk of bleeding. Professor Konstantinides describes some key considerations when assessing a patient’s risk of thrombosis and bleeding.

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Initial and primary VTE treatment

Professor Konstantinides provides an overview of treatment options for venous thromboembolism (VTE), and key factors to consider when selecting the most appropriate anticoagulant for each patient.

Treatment options for venous thromboembolism (VTE) include pharmacological anticoagulation treatments such as vitamin K antagonists (VKAs), low-molecular-weight heparin (LMWH), direct-acting oral anticoagulants (DOACs) and thrombolytic therapies.

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Secondary prevention and recurrent VTE

Beyond the primary phase, venous thromboembolism (VTE) treatment may involve secondary prevention and treatment of recurrent VTE.

Professor Konstantinides discusses key considerations when determining the duration of treatment for a patient with VTE, and when choosing an anticoagulant for secondary prevention.

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Real-world evidence for VTE management

The use of direct-acting oral anticoagulants (DOACs) for the treatment of venous thromboembolism (VTE) significantly increased with the release of clinical guidelines recommending their use. Treatment of VTE with DOACs is shown to improve overall clinical outcomes in general populations11,12 and high-risk populations, including the elderly (>65 years)13, octogenarians14, and cancer patients14.

The infographic below summarises key real-world evidence which can inform an individualised approach for managing VTE with DOACs.

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References

  1. Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS) The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Euro Heart J. 2020;41(4):543–603.
  2. Ortel TL, Neumann I, Ageno W, Beyth R, Clark NP, Cuker A, et al. American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism. Blood Adv. 2020;4(19):4693–4738.
  3. National Institute for H, Care E. Venous thromboembolic diseases: diagnosis, management and thrombophilia testing: NICE Guideline. 2020.
  4. Kakkos SK, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black SA, et al. European Society for Vascular Surgery (ESVS) 2021 clinical practice guidelines on the management of venous thrombosis. European Journal of Vascular and Endovascular Surgery. 2021;61(1):9-82.
  5. Stevens SM, Woller SC, Kreuziger LB, Vintch J, Wells P, Moores LK. Antithrombotic therapy for VTE disease, second update of the CHEST guideline and expert panel report. CHEST Journal (pulmonary vascular: guidelines and consensus statements). 2021;160(6):E545-E608.
  6. Key NS, Chb MB, Khorana AA, Kuderer NM, Bohlke K, Lee AYY, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO clinical practice guideline update. Journal of Clinical Oncology. 2019;38:496-520.
  7. NCCN Guidelines: Cancer-associated venous thromboembolic disesae (version 3). 2021.
  8. Lyman GH, Carrier M, Ay C, Di Nisio M, Hicks LK, Khorana AA. American Society of Hematology 2021 guidelines for management of venous thromboembolism: prevention and treatment in patients with cancer. Blood Adv. 2021;5(4):927–974.
  9. Mehta Y, Bhave A. A review of venous thromboembolism risk assessment models for different patient populations: What we know and don't! Medicine (Baltimore). 2023;102(2):e32398.
  10. Badescu M, Ciocoiu M, Badulescu O, Vladeanu M-C, Bojan I, Vlad C, et al. Prediction of bleeding events using the VTE‑BLEED risk score in patients with venous thromboembolism receiving anticoagulant therapy (Review). Experimental and Therapeutic Medicine. 2021;22(5).
  11. Navar AM, Kolkailah AA, Overton R, Shah NP, Rousseau JF, Flaker GC, et al. Trends in Oral Anticoagulant Use Among 436 864 Patients With Atrial Fibrillation in Community Practice, 2011 to 2020. J Am Heart Assoc. 2022;11(22):e026723.
  12. Bortoluzzi C, Bernardi E, Camporese G, Noventa F, Ceccato D, Tonello C, et al. Safety and efficacy of rivaroxaban for extended-phase anticoagulation of patients with unprovoked or recurrent venous thromboembolism: real-life data from the MAC project. Life. 2022;12(10):1657.
  13. Wu O, Morris S, Larsen TB, Skjøth F, Evans A, Bowrin K, et al. Effectiveness and safety of nonvitamin K oral anticoagulants rivaroxaban and apixaban in patients with venous thromboembolism: A meta-analysis of real-world studies. Cardiovasc Ther. 2022;2022:1-11.
  14. Ayalon-Dangur I, Vega Y, Israel MR, Grossman A, Spectre G, Shochat T, et al. Outcome of elderly patients with venous thromboembolism treated with direct oral anticoagulants—a retrospective cohort study. Journal of Clinical Medicine. 2021;10(23):5673.
  15. Douros A, Basedow F, Cui Y, Dimakos J, Walker J, Enders D, et al. Effectiveness and safety of direct oral anticoagulants among octogenarians with venous thromboembolism: an international multidatabase cohort study. The American Journal of Medicine. 2023;136(1):79-87.e77.
  16. Dawwas GK, Dietrich E, Smith SM, Davis K, Park H. Comparative effectiveness and safety of direct-acting oral anticoagulants and warfarin in patients with venous thromboembolism and active cancer: an observational analysis. Clin Ther. 2020;42(9):e161-e176.
  17. Kline JA, Adler DH, Alanis N, Bledsoe JR, Courtney DM, D’Etienne JP, et al. Monotherapy anticoagulation to expedite home treatment of patients diagnosed with venous thromboembolism in the emergency department: A pragmatic effectiveness trial. Circ Cardiovasc Qual Outcomes. 2021;14(7).
  18. Weycker D, Li X, Wygant GD, Lee T, Hamilton M, Luo X, et al. Effectiveness and safety of apixaban versus warfarin as outpatient treatment of venous thromboembolism in U.S. clinical practice. Thrombosis and Haemostasis. 2018;118(11):1951-1961.
  19. Jin MC, Sussman ES, Feng AY, Han SS, Skirboll SL, Berube C, et al. Hemorrhage risk of direct oral anticoagulants in real-world venous thromboembolism patients. Thrombosis Research. 2021;204:126-133.
  20. Westerman ME, Bree KK, Msaouel P, Kukreja JB, Mantaring C, Rukundo I, et al. Apixaban vs enoxaparin for post-surgical extended-duration venous thromboembolic event prophylaxis: A prospective quality improvement study. J Urol. 2022;208(4):886-895.
  21. Veeranki SP, Xiao Z, Levorsen A, Sinha M, Shah BR. Real-world comparative effectiveness and cost comparison of thromboprophylactic use of enoxaparin versus unfractionated heparin in 376,858 medically ill hospitalized US patients. American Journal of Cardiovascular Drugs. 2021;21(4):443-452.
  22. Rappold JF, Sheppard FR, Carmichael Ii SP, Cuschieri J, Ley E, Rangel E, et al. Venous thromboembolism prophylaxis in the trauma intensive care unit: an American Association for the Surgery of Trauma Critical Care Committee Clinical Consensus Document. Trauma Surgery & Acute Care Open. 2021;6(1):e000643.
  23. Bertoletti L, Gusto G, Khachatryan A, Quignot N, Chaves J, Moniot A, et al. Effectiveness and safety of oral anticoagulants in the treatment of acute venous thromboembolism: A nationwide comparative cohort study in France. Thrombosis and Haemostasis. 2022;122(08):1384-1396.
  24. Dawwas GK, Leonard CE, Lewis JD, Cuker A. Risk for recurrent venous thromboembolism and bleeding with apixaban compared with rivaroxaban: An analysis of real-world data. Ann Intern Med. 2022;175(1):20-28.
  25. Liu Z-Y, Zhang H-X, Ma L-Y, Mu G-Y, Xie Q-F, Zhou S, et al. Non-vitamin K antagonist oral anticoagulants in venous thromboembolism patients: a meta-analysis of real-world studies. BMC Cardiovasc Disord. 2022;22(1).
  26. Beyer-Westendorf J. What have we learned from real-world NOAC studies in venous thromboembolism treatment? Throm Res. 2018;163:83–91.
  27. Haas S, Mantovani LG, Kreutz R, Monje D, Schneider J, Zell ER, et al. Anticoagulant treatment for venous thromboembolism: A pooled analysis and additional results of the XALIA and XALIA‐LEA noninterventional studies. Research and Practice in Thrombosis and Haemostasis. 2021;5(3):426-438.
  28. Speed V, Patel JP, Roberts LN, Patel RK, Arya R. UK real-world experience of prescribing rivaroxaban for acute venous thromboembolism in obesity: Results from the FIRST Registry. Thrombosis Research. 2021;197:16-19.
  29. Berger JS, Laliberté F, Kharat A, Lejeune D, Moore KT, Jung Y, et al. Effectiveness, safety, and healthcare costs associated with rivaroxaban versus warfarin among venous thromboembolism patients with obesity: a real-world study in the United States. Journal of Thrombosis and Thrombolysis. 2022;54(3):438-448.
  30. Kepka S, Cordeanu E-M, Zarca K, Frantz A-S, Ohlmann P, Andres E, et al. A Real-World Cost-Effectiveness Analysis of Rivaroxaban versus Vitamin K Antagonists for the Treatment of Symptomatic Venous Thromboembolism: Lessons from the REMOTEV Registry. Medicina. 2023;59(1):181.
  31. Agnelli G, Hoffmann U, Hainaut P, Gaine S, Ay C, Coppens M, et al. ETNA-VTE Europe: Benefits and risks of venous thromboembolism treatment using edoxaban in the first 3 months. Thromb Res. 2020;196:297-304.
  32. Kearon C, Kahn SR. Long-term treatment of venous thromboembolism. Blood. 2020;135(5):317-325.
  33. Kang HR, Lo-Ciganic WH, DeRemer CE, Dietrich EA, Huang PL, Park H. Effectiveness and safety of extended oral anticoagulant therapy in patients with venous thromboembolism: A retrospective cohort study. Clin Pharmacol Ther. 2022;112(1):133-145.
  34. Park H, Kang HR, Huang PL, Lo‐Ciganic WH, Deremer CE, Wilson D, et al. Comparative effectiveness and safety of extended anticoagulant therapy among Medicare beneficiaries with venous thromboembolism. Clinical and Translational Science. 2023;16(1):128-139.
  35. de Winter MA, Büller HR, Carrier M, Cohen AT, Hansen J-B, Kaasjager KAH, et al. Recurrent venous thromboembolism and bleeding with extended anticoagulation: the VTE-PREDICT risk score. European Heart Journal. 2023.
  36. Piazza G. Walking the tightrope: a balanced discussion of the benefits and harms of extended duration anticoagulation for venous thrombo-embolism. European Heart Journal. 2023

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