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

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

June 27, 2006

    LISBON, Portugal, June 27 /Xinhua-PRNewswire/ -- 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
editorial committee of the Guidelines.

    "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,
co-chairman of the editorial committee of the guidelines.

    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 hormone therapy
(contraceptive treatments...) often set against a
background of thrombophilia.

    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.

    For more information, please contact:

     Dr. Evi Klodicki, 
     Co-chair Scientific Committee, IUA 
     Tel:   [phone] 

SOURCE  The International Union of Angiology