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Know Thy Guidelines

By Ayesha Zia, MD

 There is only one thing in the world worse than being talked about, and that is not being talked about.”

– Oscar Wilde, The Picture of Dorian Grey, 1891

For years, venous thromboembolism (VTE) was nobody’s disease, until it became everyone’s problem, as care and survival for acute and chronic medical disorders improved. We have come a long way from the first well-documented case of deep vein thrombosis reported during the middle ages, to thrombosis in pregnancy believed to occur from retention of “evil humors.” Despite that, the field of VTE has lagged. That is, until 2014, when the impetus for VTE clinical practice guidelines arose in response to long-standing interest. High-quality, evidence-informed clinical practice guidelines offer a way of bridging the gap between policy, best practice, local contexts, and patient choice. Embracing the overarching value of clinical practice guidelines — to optimize care informed by evidence and the benefits and harms of alternative care options — ASH initiated an effort to develop evidence-based guidelines for VTE that meet the highest standards of development rigor and trustworthiness. Cultivation of these guidelines, including systematic evidence review, was supported by the McMaster University GRADE Center. Ten guideline panels, which include more than 100 thrombosis experts, reviewed evidence and formulated more than 200 recommendations on VTE. The VTE Clinical Practice Guidelines are envisioned to be more than a body of writings or a typology of forms; first and foremost, they will be an evolving set of practices that will engage many stakeholders and that are engaged by the intellectual work of others.

In a special education session chaired by Adam Cuker, MD, MS, of the University of Pennsylvania, four panelists presented evidence packaged into particularly notable recommendations on four topics and discussed important considerations for their practical application. Susan Kahn, MD, of McGill University discussed “Prophylaxis of VTE in Hospitalized Medical Patients.” Wendy Lim, MD, MSc, of McMaster University focused on “Diagnosis of VTE.” Walter Ageno, MD, of the University of Insubria in Varese, Italy, discussed guidelines on the “Treatment of VTE.” Shannon M. Bates, MD, MSc, of McMaster University, highlighted guidelines encompassing “VTE in the Context of Pregnancy.”

The speakers highlighted that VTE clinical practice guidelines are evolving processes. What will follow eventually will be codes of best practices devised specifically by and for the VTE community. They anticipate that the next decade will see significant further research to underpin best practices within these activities. While poor adherence is the principal argument against guidelines, we hope that the VTE community will join hands in embracing and implementing these clinical practice guidelines.

 Dr. Zia indicated no relevant conflicts of interest.

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