A panel that was formed as a collaboration between the American Society of Hematology (ASH) and 12 Latin American hematology societies convened to develop guidelines for management of venous thromboembolism (VTE) in Latin America. Guidelines were recently presented in the journal Blood Advances.
According to the authors of the report, VTE occurs with an estimated incidence of 1.65 per 1000 individuals per year, based on analysis of a 1138-person cohort from Argentina. The incidence was 5.9 per 1000 per year with older adults in this cohort. The authors also noted a socioeconomic gap occurs in Latin America and that the establishment of some technologies varies at medical centers across the region.
Recommendations in the guidelines were adapted from ASH guidelines on treatment of VTE and anticoagulation therapy, with 18 questions prioritized with consideration of Latin American context. The panel consisted of medical professionals from 10 Latin American nations. Recommendations by this Latin American panel were graded as “strong” or “conditional.”
A total of 17 recommendations showed agreement by panelists. Changes in direction from the original ASH guidelines were made for 4 recommendations, with another guideline receiving a change in strength.
The Latin American panel made changes in direction from original guidelines for the following recommendations:
- Home or hospital treatment was recommended over strictly home-based treatment for patients with pulmonary embolism (PE) who had a low risk of complications.
- For patients with recurrent provoked deep vein thrombosis (DVT) or PE and high recurrence risk, the Latin American panel recommended indefinite anticoagulation, rather than discontinuation after 3 to 6 months, depending on risk factors.
- For cases of indefinite direct oral anticoagulant (DOAC) use following initial therapy, the panel recommended standard-dose DOAC therapy, rather than with the option of reduced dose DOAC therapy, except in cases such as high bleeding risk or if VTE risk is not high.
- In the presence of vitamin K antagonist-related life-threatening bleeding while being treated for a VTE, the panel recommended either 4-factor prothrombin complex concentrates (PCCs) or fresh frozen plasma (FFP), rather than PCC use only.
The change in a recommendation’s strength involved a recommendation regarding treatment of provoked DVT or PE. Although original guidelines reportedly gave a conditional recommendation of indefinite anticoagulation, the Latin American panel gave a strong recommendation.
Adjustments to recommendations tailored to the Latin American setting frequently seemed to involve consideration of relevant medical risks and/or the likely availability of appropriate therapy options in the region.
Disclosures: Some authors have declared affiliations with or received grant support from the pharmaceutical industry. Please refer to the original study for a full list of disclosures.
Neumann I, Izcovich A, Aguilar R, et al. ASH, ABHH, ACHO, Grupo CAHT, Grupo CLAHT, SAH, SBHH, SHU, SOCHIHEM, SOMETH, Sociedad Panameña de Hematología, SPH, and SVH 2021 guidelines for management of venous thromboembolism in Latin America. Blood Adv. 2021;5(15):3032-3046. doi:10.1182/bloodadvances.2021004267