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HelixTalk Episode #50 - Three shocking recommendations from CHEST 2016 that will blow your mind

Date posted: October 4, 2016, 6:00 am

In this episode, we discuss three shocking recommendations from the CHEST 2016 VTE guideline update.  We focus on (1) the debate between NOAC, DOAC, or TSOAC nomenclature, (2) the controversial recommendation of preferring NOACs over warfarin in VTE treatment, and (3) the efficacy of compression stocking for prevention and treatment of post-thrombotic syndrome.

 

Key Concepts

  1. The CHEST guidelines use the acronym “NOAC” (non-vitamin K oral anticoagulant) to refer to dabigatran, rivaroxaban, apixaban, and edoxaban.  Historically, the “N” in “NOAC” has also referred to “new” and “novel”.
  2. The CHEST guidelines prefer NOACs over warfarin for the treatment of a venous thromboembomism (VTE), although this is a weak (grade 2B) recommendation.
  3. The NOACs are just as effective as warfarin in preventing recurrent VTEs.
  4. In patients with VTE, apixaban definitely has less bleeding than warfarin; rivaroxaban might have less bleeding than warfarin; dabigatran and edoxaban appear to be similar in bleeding risk to warfarin.
  5. Graduated or elastic compression stockings are no longer recommended for the prevention of post-thrombotic syndrome (PTS) after a proximal deep vein thrombosis (DVT); however, they may be considered for the treatment of acute or chronic symptoms if PTS develops.

References

  1. Kearon C, Akl EA, Ornelas J, et al. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest. 2016 Feb;149(2):315-52. doi: 10.1016/j.chest.2015.11.026.
  2. Barnes GD, Ageno W, Ansell J, et al. Recommendation on the nomenclature for oral anticoagulants: communication from the SSC of the ISTH.J Thromb Haemost. 2015 Jun;13(6):1154-6.
  3. Kahn SR, Shapiro S, Wells PS, et al. Compression stockings to prevent post-thrombotic syndrome: a randomized placebo-controlled trial.Lancet. 2014 Mar 8;383(9920):880-8. doi: 10.1016/S0140-6736(13)61902-9.