Two physicians from the University of Tennessee Health Science Center were invited to an expert panel review of clinical guidelines for the treatment of venous thromboembolisms.
Venous Thromboembolism refers to a medical condition in which blood clots form in the lower veins of the leg (deep vein thrombosis) or in the lungs (pulmonary embolism). The condition is usually diagnosed after a clot is already established, since early symptoms often go unnoticed. Treatment typically involves administering strong anticoagulants intravenously while under close observation in an inpatient setting.
Desiree Burroughs-Ray, MD, MPH, and Christopher Jackson, MD, FACP, FSSCI, were invited to join other experts in a review of the guidelines written by the American College of Chest Physicians. After analyzing years of new data collected in the form of clinical trials, randomized controlled trials, and systematic reviews, the Journal of American Medical Association published the panel’s new recommendations as a clinical guidelines synopsis.
The analysis and review led the panel to make new recommendations for treatment, which include a more prominent role for a class of drugs previously used for less-severe cases. While intravenous clot busters have been often prescribed for thromboembolisms, they bring risks including bruising, excessive bleeding, shortness of breath, fever, and elevated potassium levels in the blood. This treatment must be done over the course of a few days under supervision in a hospital.
The new recommendations advise using direct-acting oral anticoagulants (DOACs) in more-severe cases than previously thought possible. DOACs have less serious risks than other treatment options and can be self-administered at home by the patient. “In the mid-2000s, there was a lot of data being published about the efficacy of DOACs; five or six studies came out saying patient populations with clots had results just as good or better than other treatments,” said Dr. Jackson, who serves as an assistant professor of Medicine and associate program director for the Internal Medicine Residency at UTHSC.
A big challenge in treating the condition comes from the fact that early symptoms are hard for patients to notice. “When patients come in, they are usually coming in for some reason other than a suspected blood clot. When the thrombosis is found, it is usually already causing strain on the heart,” said Dr. Burroughs-Ray, who practices general internal medicine and pediatrics at Le Bonheur Children’s Hospital. “There is no way to simply make the clots disappear. The treatments available at this stage, like manually removing the clot or using clot-busting drugs, have risks associated with them,” Dr. Burroughs-Ray said.
The doctors are excited to put the changes into practice themselves, and to see the results. “As a hospitalist, I have the benefit of putting these guidelines into action on a daily basis and I get to have an impact on the next group of trainees and help them internalize these practices,” Dr. Burroughs-Ray said. Dr. Jackson added that the efficacy of the new treatment recommendations should be observable in just a few years.