Clotblog with Dr Samuel Goldhaber

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CHEST/ACCP 2012 guidelines: What's new?

Feb 24, 2012 07:45 EST


For the ninth edition, the American College of Chest Physicians' (ACCP) antithrombotic guidelines have been overhauled, slimming down to 70 pages of succinct bottom-line recommendations. Find out more.

See also:

Chest 2012; 141(2):1S-70S. Available here.

New ACCP thrombosis guidelines offer weak support for aspirin in primary prevention





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Your comments
CHEST/ACCP 2012 guidelines: What's new?
# 1 of 6
March 2, 2012 09:19 (EST)
Jim Mason MD

The guidelines, 2008, state in their comments that bolus thrombolytics for urgent treatment of massive PE is indicated when CPR is required or imminent. But they do not state as a gudeline recommendation and they do not offer any recommendations about dose.

I wonder if you could share with me the dose of rt-PA used at your institution for  these critically ill patients in shock who you feel will not survive the 2hours required for standard rt-PA therapy(100mg over 2 hours)

 

Jim Mason, MD
# 2 of 6
March 2, 2012 02:23 (EST)
Jack Hirsh

Hi Sam. Just to say that I enjoy your blog and find it both fair and informative 

 
# 3 of 6
March 2, 2012 05:40 (EST)
Sam Goldhaber, MD
An evidence-based regimen that you can use when time is of the essence is a 15 minute infusion of rt-PA 0.6 mg/kg, with a maximum dose of 50 mg.  In a small randomized trial, the 15 minute infusion regimen had similar efficacy and safety compared with the standard 100 mg/2 hour dosing.  The citation is:  CHEST 1994; 106: 725-726.
# 4 of 6
June 19, 2012 01:54 (EDT)
KG

What is the evidence for graduated compression stockings (TED-type hose) in non-surgical hospitalized patients?   Does it reduce DVTs in medical hospitalized patients?
# 5 of 6
July 9, 2012 03:43 (EDT)
KD
The problen with SCDs is that in my hospital they are ordered and draped over the foot of the bed...but they are rarely on the patient.  Nursing always has a litany of excuses why they were not on the patient at the time I make rounds...tid.
# 6 of 6
August 14, 2012 11:21 (EDT)
Merchanc
In regard to enoxaparin what does the new chest guidelines recommend for patients with a CrCL < 30 ml/min and obese patients in respect to prophylaxis and treatment of VTE?

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Who's Talking
Samuel Z Goldhaber, MD
Professor of Medicine
Harvard Medical School
Director, Venous Thromboembolism Research Group
Co-Director, Anticoagulation Management Service
Cardiovascular Division
Brigham and Women's Hospital
Boston, MA