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Brief Summary

GUIDELINE TITLE

Antithrombotic therapy in children: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy.

BIBLIOGRAPHIC SOURCE(S)

GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previous version: Monagle P, Michelson AD, Bovill E, Andrew M. Antithrombotic therapy in children. Chest 2001 Jan;119(1 Suppl):344S-370S.

** REGULATORY ALERT **

FDA WARNING/REGULATORY ALERT

Note from the National Guideline Clearinghouse: This guideline references a drug(s) for which important revised regulatory and/or warning information has been released.

  • February 28, 2008, Heparin Sodium Injection: The U.S. Food and Drug Administration (FDA) informed the public that Baxter Healthcare Corporation has voluntarily recalled all of their multi-dose and single-use vials of heparin sodium for injection and their heparin lock flush solutions. Alternate heparin manufacturers are expected to be able to increase heparin production sufficiently to supply the U.S. market. There have been reports of serious adverse events including allergic or hypersensitivity-type reactions, with symptoms of oral swelling, nausea, vomiting, sweating, shortness of breath, and cases of severe hypotension.
  • August 16, 2007, Coumadin (Warfarin): Updates to the labeling for Coumadin to include pharmacogenomics information to explain that people's genetic makeup may influence how they respond to the drug.

BRIEF SUMMARY CONTENT

 ** REGULATORY ALERT **
 RECOMMENDATIONS
 EVIDENCE SUPPORTING THE RECOMMENDATIONS
 IDENTIFYING INFORMATION AND AVAILABILITY
 DISCLAIMER

 Go to the Complete Summary

RECOMMENDATIONS

MAJOR RECOMMENDATIONS

The rating scheme is defined at the end of the "Major Recommendations" field.

Specific Indications for Antithrombotic Therapy

Venous Thromboembolism (VTE)

Neonates with VTE

  1. The guideline developers suggest treatment with either unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH), or radiographic monitoring and anticoagulation therapy if extension occurs (Grade 2C).
  2. The guideline developers suggest that if clinicians elect treatment with anticoagulation therapy, they administer UFH or LMWH, and subsequently administer LMWH for 10 days to 3 months (Grade 2C).
  3. The guideline developers suggest that clinicians adjust the dose of UFH to prolong the activated partial thromboplastin time (aPTT) corresponding to an anti-factor Xa (anti-FXa) level of 0.35 to 0.7 U/mL (Grade 2C).
  4. The guideline developers suggest that clinicians adjust the dose of LMWH to achieve an anti-FXa level of 0.5 to 1.0 U/mL (Grade 2C).
  5. The guideline developers suggest that if the thrombus extends following the discontinuation of heparin therapy, clinicians administer vitamin K antagonists (VKAs) or extended LMWH therapy (Grade 2C).
  6. The guideline developers suggest that clinicians not use thrombolytic therapy for the treatment of VTEs in neonates unless there is major vessel occlusion that is causing the critical compromise of organs or limbs (Grade 2C). If thrombolytic therapy is used, the guideline developers suggest supplementation with plasminogen (i.e., fresh frozen plasma [FFP]) immediately prior to thrombolysis (Grade 2C).
  7. The guideline developers suggest that, in general, clinicians should remove either central venous lines (CVLs) or umbilical vein catheters (UVCs) that are in situ. However, if either CVLs or UVCs are still in place at the completion of the above therapy, the guideline developers suggest prophylactic dosing with LMWH to prevent recurrent VTEs until such time as the CVL or UVC is removed (both Grade 2C).

Systemic Venous Thromboembolic Disease in Children

First Thromboembolic Event (TE) for Children (>2 months of age)

  1. The guideline developers recommend treatment with intravenous (IV) heparin sufficient to prolong the aPTT to a range that corresponds to an anti-FXa level of 0.35 to 0.7 U/mL or with LMWH sufficient to achieve an anti-FXa level of 0.5 to 1.0 U/mL 4 hours after an injection (Grade 1C+).
  2. The guideline developers recommend initial treatment with heparin or LMWH for 5 to 10 days (Grade 1C+). For patients in whom subsequent VKAs will be used, the guideline developers recommend beginning oral therapy as early as day 1 and discontinuing heparin/LMWH therapy on day 6 if the international normalized ratio (INR) is in the therapeutic range on two consecutive days (Grade 1C+). For massive pulmonary embolisms (PEs) or extensive deep vein thrombosis (DVT), the guideline developers recommend a longer period of heparin or LMWH therapy (Grade 1C+).
  3. The guideline developers suggest continuing anticoagulant therapy for idiopathic TEs for at least 6 months using VKAs to achieve a target INR of 2.5 (INR range, 2.0 to 3.0) or, alternatively, LMWH to maintain an anti-FXa level of 0.5 to 1.0 U/mL (Grade 2C).

    Underlying values and preferences: The suggestion to administer anticoagulation therapy to children with idiopathic DVT for at least 6 months rather than on a lifelong basis places a relatively high value on the avoidance of the known risk of bleeding secondary to anticoagulant therapy in young active adults, and less importance on the unknown risk of recurrence in the absence of an ongoing clinical precipitating factor.

  4. The guideline developers suggest that for secondary TEs anticoagulant therapy be continued for at least 3 months using VKAs to achieve a target INR of 2.5 (INR range, 2.0 to 3.0) or, alternatively, using LMWH to maintain an anti-FXa level of 0.5 to 1.0 U/mL (Grade 2C).
  5. The guideline developers suggest that, in the presence of ongoing risk factors such as active nephrotic syndrome, ongoing asparaginase therapy, or administration of a lupus anticoagulant, anticoagulant therapy in either therapeutic or prophylactic doses continue until the risk factor has resolved (Grade 2C).
  6. The guideline developers suggest that clinicians not use thrombolytic therapy routinely for the treatment of venous TE in children (Grade 2C). Treatment needs to be individualized, and based on the size and location of the thrombus, and the degree of organ compromise. If thrombolytic therapy is used, in the presence of physiologic or pathologic deficiencies of plasminogen, the guideline developers suggest supplementation with plasminogen (i.e., FFP) [Grade 2C].

Recurrent Idiopathic TEs in Children

  1. The guideline developers recommend indefinite therapy with either therapeutic or prophylactic doses of VKAs (Grade 1C+). The guideline developers suggest LMWH therapy as an alternative if VKA therapy is too difficult (Grade 2C).

Recurrent Secondary TEs in Children

  1. The guideline developers suggest that, following the initial 3 months of therapy, anticoagulation therapy be continued for at least a further 3 months or until removal of any precipitating factors (Grade 2C).

CVL-Related Thrombosis

There are two aspects to the management of CVL-related thrombosis. First, management of the CVL itself and, second, anticoagulation therapy.

  1. The guideline developers suggest that if the CVL is no longer required, or is nonfunctioning, it be removed (Grade 2C). The guideline developers suggest at least 3 to 5 days of anticoagulation therapy prior to its removal. If CVL access is required and the CVL involved is still functioning, the guideline developers suggest that the CVL remain in situ (Grade 2C). Anticoagulation therapy should be administered as described in the recommendations above listed under "First TE for children (>2 months of age)."
  2. For children with a first CVL-related DVT after the initial 3 months of therapy, the guideline developers suggest that prophylactic doses of VKAs (INR range, 1.5 to 1.8) or LMWH (anti-FXa level range, 0.1 to 0.3) be administered until the CVL is removed (Grade 2C).
  3. For children with recurrent CVL-related TEs after the initial 3 months of therapy, the guideline developers suggest prophylactic doses of VKAs (INR range, 1.5 to 1.8) or LMWH (anti-FXa level range, 0.1 to 0.3) be continued until the removal of the CVL. If the recurrence occurs while children are receiving prophylactic therapy, the guideline developers suggest continuing therapeutic doses until the CVL is removed or for a minimum of 3 months (Grade 2C).

Renal Vein Thrombosis (RVT)

  1. For unilateral RVT in the absence of uremia, and in the absence of extension into the inferior vena cava (IVC), the guideline developers suggest supportive care with careful monitoring of the RVT for extension (Grade 2C). Alternatively, the guideline developers suggest anticoagulation therapy with UFH or LMWH (Grade 2C).
  2. For unilateral RVT that does extend into the IVC, the guideline developers suggest anticoagulation therapy with UFH or LMWH for 6 weeks to 3 months (Grade 2C).

    Remark: The therapeutic range is the same as that for treatment of venous thrombosis.

  3. For bilateral RVT with various degrees of renal failure, the guideline developers suggest therapy with UFH (and not LMWH) and thrombolytic therapy (Grade 2C).

CVL Prophylaxis

  1. For children with CVLs, the guideline developers recommend against routine primary prophylaxis (Grade 1B).
  2. For children receiving long-term home total parenteral nutrition (TPN), the guideline developers suggest antithrombotic prophylaxis. The guideline developers suggest continuous therapy with VKAs (target INR, 2 to 2.5) or, alternatively, for the first 3 months after each CVL is inserted (all Grade 2C).

    Remark: The optimal drug and dose are unknown.

Primary Prophylaxis for Blalock-Taussig (BT) Shunts in Neonates

  1. For neonates having BT shunts, the guideline developers suggest therapy with intraoperative heparin followed by either aspirin (5 mg/kg/day) or no further anticoagulant therapy (Grade 2C).

Primary Prophylaxis for Stage 1 Norwood Procedures in Neonates

  1. For patients who have undergone the Norwood procedure, the guideline developers suggest heparin therapy immediately after the procedure (Grade 2C).

Primary Prophylaxis for Fontan Surgery in Children

  1. For children after Fontan surgery, the guideline developers suggest therapy with aspirin (5 mg/kg/day) or therapeutic heparin followed by VKAs to achieve a target INR of 2.5 (INR range, 2 to 3) (Grade 2C).

    Remark: The optimal duration of therapy is unknown. Whether patients with fenestrations require more intensive therapy until fenestration closure is unknown.

Primary Prophylaxis for Endovascular Stents in Children

  1. For children having endovascular stents inserted, the guideline developers suggest the administration of heparin perioperatively (Grade 2C).

Primary Prophylaxis for Dilated Cardiomyopathy in Neonates and Children

  1. For children with cardiomyopathy, the guideline developers suggest that they receive VKAs to achieve a target INR of 2.5 (INR range, 2 to 3) commencing no later than at the time of their activation on a cardiac transplant waiting list (Grade 2C).

    Underlying values and preferences: The suggestion for the administration of VKAs places a high value on avoiding thrombotic complications, and a relatively low value on avoiding the inconvenience, discomfort, and limitations of anticoagulant monitoring in children who have a potentially curative therapy (for their cardiomyopathy) available to them.

Primary Prophylaxis for Biological Prosthetic Heart Valves in Children

  1. For children with biological prosthetic heart valves, the guideline developers recommend treatment according to the adult guidelines (see the National Guideline Clearinghouse (NGC) summary of the American College of Chest Physicians guideline Antithrombotic therapy in valvular heart disease – native and prosthetic) (Grade 1C+).

Primary Prophylaxis for Mechanical Prosthetic Heart Valves in Children

  1. For children with mechanical prosthetic heart valves, the guideline developers recommend the administration of VKAs following adult guidelines (see the NGC summary Antithrombotic therapy in valvular heart disease – native and prosthetic) for the intensity of therapy (i.e., target INRs) (Grade 1C+).
  2. In children in whom additional antithrombotic therapy is required due to lack of response to therapy with VKAs or a contraindication to therapy with full-dose VKAs, the guideline developers suggest adding therapy with aspirin (6 to 20 mg/kg/day) (Grade 2C).

Thromboprophylaxis for Cardiac Catheterization (CC) in Neonates and Children

  1. For neonates and children requiring CC via an artery, the guideline developers recommend IV heparin prophylaxis (Grade 1A).
  2. The guideline developers suggest the use of heparin doses of 100 to 150 U/kg as a bolus. Further doses may be required in prolonged procedures (both Grade 2B).
  3. For prophylaxis for CC, the guideline developers recommend against aspirin therapy (Grade 1B).

Femoral Artery Thrombosis Following CC

  1. For children or neonates with a femoral artery thrombosis, the guideline developers recommend therapeutic doses of IV heparin (Grade 1C). The guideline developers suggest treatment for at least 5 to 7 days (Grade 2C).

    Remark: The optimal duration of therapy is unknown.

  2. For children or neonates with limb-threatening or organ-threatening (via proximal extension) femoral artery thrombosis who fail to respond to initial heparin therapy, and who have no known contraindications, the guideline developers recommend the administration of thrombolytic therapy (Grade 1C).
  3. For children with femoral artery thrombosis in selected cases, the guideline developers suggest surgical intervention, in particular when there is a contraindication to thrombolytic therapy, or when organ or limb death is imminent (Grade 2C).

Peripheral Artery Thrombosis

  1. For neonates and children with peripheral arterial catheters in situ, the guideline developers recommend the administration of low-dose heparin through the catheter, preferably by continuous infusion, to prolong the catheter patency (Grade 1A).
  2. For children with a peripheral arterial catheter-related TE, the guideline developers suggest the immediate removal of the catheter (Grade 2C). The guideline developers suggest subsequent anticoagulation therapy with or without thrombolysis, depending on the clinical situation (Grade 2C).

Aortic Thrombosis Secondary to Umbilical Arterial Catheters (UACs) in Neonates

  1. For neonates with UACs, the guideline developers suggest therapy with low-dose heparin infusion (1 to 5 U/hour) (Grade 2A).
  2. The guideline developers suggest that aortic thrombosis secondary to UACs be managed by the same principles as those for femoral artery thrombosis secondary to cardiac catheters. If there is evidence of renal failure, then urgent restoration of renal blood flow is required, and the guideline developers suggest thrombolysis or thrombectomy (all Grade 2C).

Spontaneous Aortic Thrombosis in Neonates

  1. For children experiencing spontaneous aortic thrombosis with evidence of renal ischemia, the guideline developers suggest urgent, aggressive use of thrombolytic or surgical therapy, supported by anticoagulation therapy with heparin or LMWH (Grade 2C).

Kawasaki Disease in Children

  1. The guideline developers recommend aspirin therapy in high doses (i.e., 80 to 100 mg/kg/day during the acute phase, for up to 14 days) as an anti-inflammatory agent, then in lower doses (i.e., 3 to 5 mg/kg/day for > 7 weeks) as an antiplatelet agent (Grade 1C+).
  2. The guideline developers recommend therapy with IV gammaglobulin (2 g/kg as a single dose) within 10 days of the onset of symptoms (Grade 1A).

Anticoagulation Therapy for Kawasaki Disease in Children with Giant Aneurysms

  1. In children with giant coronary aneurysms following Kawasaki disease, the guideline developers suggest therapy with warfarin (target INR, 2.5; INR range, 2.0 to 3.0) in addition to low-dose aspirin (Grade 2C).

Sinovenous Thrombosis in Neonates

  1. For neonates with cerebral sinovenous thrombosis (CSVT), without large ischemic infarctions or intracranial hemorrhage (ICH), the guideline developers suggest initial treatment with either UFH or LMWH followed by treatment with LMWH for 3 months (Grade 2C).
  2. For neonates with CSVT, with large ischemic infarctions or ICH, the guideline developers suggest radiographic monitoring and the commencement of anticoagulation therapy if extension occurs (Grade 2C).

Sinovenous Thrombosis in Children

  1. For children with CSVT, the guideline developers suggest treatment for 5 to 7 days with either UFH or LMWH followed by treatment with LMWH or VKAs (target INR, 2.5; INR range, 2.0 to 3.0) for 3 to 6 months even in the presence of a localized hemorrhagic infarction (Grade 2C).

Arterial Ischemic Stroke (AIS) in Neonates

  1. For neonates with noncardioembolic AIS, the guideline developers suggest that clinicians do not use anticoagulation or aspirin therapy (Grade 2C).
  2. For neonates with cardioembolic AIS, the guideline developers suggest anticoagulation therapy with either UFH or LMWH for 3 months (Grade 2C).

AIS in Children

  1. For children with AIS, the guideline developers suggest treatment with UFH or LMWH for 5 to 7 days and until cardioembolic stroke or vascular dissection has been excluded (Grade 2C).
  2. For children with AIS and cardioembolic stroke or vascular dissection, the guideline developers suggest treatment for 5 to 7 days with UFH or LMWH followed by treatment with LMWH or VKAs for 3 to 6 months (Grade 2C).
  3. For all children with AIS, the guideline developers suggest treatment with 2 to 5 mg/kg/day aspirin after anticoagulation therapy has been discontinued (Grade 2C).
  4. For children with sickle cell disease who are >2 years of age, the guideline developers recommend screening for stroke using transcranial Doppler imaging. If transcranial Doppler imaging is unavailable, the guideline developers recommend intermittent screening with magnetic resonance imaging (MRI) (Grade 1C).
  5. For children with sickle cell disease who have ischemic stroke, the guideline developers recommend therapy with IV hydration and exchange transfusion to reduce hemoglobin S levels to <30% of total hemoglobin (Grade 1C).
  6. For children with sickle cell disease who have ischemic stroke, after an initial exchange transfusion the guideline developers suggest a long-term transfusion program (Grade 2C).

Purpura Fulminans

  1. For neonates with homozygous protein C (PC) deficiency, the guideline developers recommend the administration of either 10 to 20 mL/kg FFP every 12 hours or PC concentrate, when available, at a concentration of 20 to 60 U/kg until the clinical lesions resolve (Grade 1C+).
  2. The guideline developers suggest long-term treatment with VKAs (Grade 2C), LMWH (Grade 2C), PC replacement (Grade 1C+), or liver transplantation (Grade 2C).

Definitions

Grade of Recommendation Clarity of Risk/Benefit Methodological Strength of Supporting Evidence Implications
1A

Clear

Randomized controlled trials (RCTs) without important limitations

Strong recommendation; can apply to most patients in most circumstances without reservation
1C+

Clear

No RCTs, but strong RCT results can be unequivocally extrapolated, or overwhelming evidence from observational studies

Strong recommendation; can apply to most patients in most circumstances
1B

Clear

RCTs with important limitations (inconsistent results, methodological flaws*)

Strong recommendation; likely to apply to most patients
1C

Clear

Observational studies

Intermediate-strength recommendation; may change when stronger evidence is available
2A

Unclear

RCTs without important limitations

Intermediate-strength recommendation; best action may differ depending on circumstances or patients' or societal values
2C+

Unclear

No RCTs, but strong RCT results can be unequivocally extrapolated, or overwhelming evidence from observational studies

Weak recommendation; best action may differ depending on circumstances or patients' or societal values
2B

Unclear

RCTs with important limitations (inconsistent results, methodological flaws*)

Weak recommendation; alternative approaches likely to be better for some patients under some circumstances
2C

Unclear

Observational studies

Very weak recommendation; other alternatives may be equally reasonable

*These situations include RCTs with both lack of blinding and subjective outcomes, where the risk of bias in measurement of outcomes is high, or RCTs with large loss to follow-up.

CLINICAL ALGORITHM(S)

None provided

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EVIDENCE SUPPORTING THE RECOMMENDATIONS

TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations").

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IDENTIFYING INFORMATION AND AVAILABILITY

BIBLIOGRAPHIC SOURCE(S)

ADAPTATION

Not applicable: The guideline was not adapted from another source.

DATE RELEASED

2001 Jan (revised 2004 Sep)

GUIDELINE DEVELOPER(S)

American College of Chest Physicians - Medical Specialty Society

SOURCE(S) OF FUNDING

Funding was provided through an unrestricted educational grant by AstraZeneca LP, Aventis Pharmaceuticals, GlaxoSmithKline, Bristol-Myer Squibb/Sanofi-Synthelabo Partnership, and Organon Sanofi-Synthelabo LLC.

GUIDELINE COMMITTEE

American College of Chest Physicians Consensus Panel on Antithrombotic and Thrombolytic Therapy

COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

Primary Authors: Paul Monagle, MBBS, MSc, MD, FCCP; Anthony Chan, MBBS; Patti Massicotte, MD, MSc; Elizabeth Chalmers, MDChB, MD; Alan D. Michelson, MD

Committee Co-Chairs: Jack Hirsh, MD, FCCP (Chair); Gregory W. Albers, MD; Gordon H. Guyatt, MD, MSc; Holger J. Schünemann, MD, MSc, PhD, FCCP

Participants: Giancarlo Agnelli, MD; Amin Al-Ahmad, MD; Pierre Amarenco, MD; Jack E. Ansell, MD; Shannon M. Bates, MD; Richard C. Becker, MD; Peter B. Berger, MD; David Bergqvist, MD, PhD, FRCS; Rebecca J. Beyth, MD, MSc; Stewart Brower, MLIS; Harry R. Buller, MD; Henry I. Bussey, PharmD, FCCP; Christopher P. Cannon, MD, FACC; Elizabeth A. Chalmers, MB, ChB, MD, MRCP(UK). FRCPath; Anthony K.C. Chan, MD; G. Patrick Clagett, MD; Barry Coller, MD; Clifford W. Colwell, MD; Deborah Cook, MD, MSc; James E. Dalen, MD, MPH, FCCP; J. Donald Easton, MD; Michael Ezekowitz, MD; Garret A. Fitzgerald, MD; William H. Geerts, MD, FCCP; Jeffrey S. Ginsberg, MD, FCCP; Alan S. Go, MD; Shaun D. Goodman, MD, FACC; Ian A. Greer, MD, FRCP, FRCOG; Andreas Greinacher, MD; Jeremy Grimshaw, MD, PhD; Cindy Grines, MD; Jonathan L. Halperin, MD; Robert A. Harrington, MD; John Heffner, MD, MPH; John A. Heit, MD; Judith S. Hochman, MD, FACC; Dieter Horstkotte, MD, FESC; Russell D. Hull, MBBS, MSc, FCCP; Elaine Hylek, MD; Thomas M. Hyers, MD, FCCP; Mark R. Jackson, MD; Alan Jacobson, MD; Roman Jaeschke, MD, MSc; Ajay Kakkar BSc, PhD; Clive Kearon, MD, PhD, FCCP; Matthew Kraay; Michael R. Lassen, MD; Mark N. Levine, MD, MSc; Alessandro Liberati, MD; Gregory YH Lip, MD, FESC, FACC; Warren J. Manning, MD; M. Patricia Massicotte, MD, MSc, FRCPC, MSc; Thomas W. Meade, MD; Venu Menon, MD, FACC; Alan D. Michelson, MD; Nancy Miller, RN; Paul Monagle, MBBS, MSc, MD, FRACP, FRCPA, FCCP; Heather Munger, MLS; Christopher M. O’Connor, MD; Martin O’Donnell, MD; E. Magnus Ohman, MD, FCCP; Carlo Patrono, MD; Stephen G. Pauker, MD; Graham F. Pineo, MD; Leon Poller, MD; Jeffrey J. Popma, MD; Martin H. Prins, MD; Robert Raschke, MD, MS; Gary Raskob, PhD; Joel G. Ray, MD, MSc; Gerald Roth, MD; Ralph L. Sacco, MD; Deeb N. Salem, MD, FCCP; Meyer M. Samama, MD; Andrew Schafer; Sam Schulman, MD, PhD; Daniel Singer, MD; Michael Sobel, MD; Paul D. Stein, MD, FCCP; Marco Tangelder, MD; Victor F. Tapson, MD, FCCP; Philip Teal, MD; Raymond Verhaeghe, MD; David A. Vorchheimer, MD; Theodore E. Warkentin, MD; Jeffrey Weitz, MD; Robert G. Wilcox, MD

FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Dr. Chan has received research funding from Leo Pharma and Pfizer, and has received honoraria for his participation on the advisory boards from Aventis Pharma, Bayer, and Wyeth.

Dr. Massicotte has received research funding from Leo Pharma and Pfizer and AstraZeneca and has received honoraria for her participation on the advisory boards and/or as a speaker at educational events from AstraZeneca, Aventis Pharma, Lifescan, Leo Pharma, Sanofi-Synthelabo-Organon, and Bristol-Myers Squibb.

Dr. Michelson has received research funding from Centocor, Lilly, Bristol-Myers Squibb and Sanofi-Synthelabo.

GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previous version: Monagle P, Michelson AD, Bovill E, Andrew M. Antithrombotic therapy in children. Chest 2001 Jan;119(1 Suppl):344S-370S.

GUIDELINE AVAILABILITY

Electronic copies: Available from the Chest - The Cardiopulmonary and Critical Care Journal.

Print copies: Available from the American College of Chest Physicians, Products and Registration Division, 3300 Dundee Road, Northbrook IL 60062-2348.

AVAILABILITY OF COMPANION DOCUMENTS

The following are available:

  • The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Evidence-based guidelines. Northbrook, IL: ACCP, 2004 Sep.
  • Methodology for guideline development for the Seventh American College of Chest Physicians Conference on Antithrombotic and Thrombolytic Therapy. Northbrook, IL: ACCP, 2004 Sep.
  • Applying the grades of recommendation for antithrombotic and thrombolytic therapy: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Northbrook, IL: ACCP, 2004 Sep.
  • Hemorrhagic complications of anticoagulant treatment: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Northbrook, IL: ACCP, 2004 Sep.
  • Antithrombotic and thrombolytic therapy: from evidence to application: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Northbrook, IL: ACCP, 2004 Sep.
  • Platelet-active drugs: the relationships among dose, effectiveness, and side effects: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Northbrook, IL: ACCP, 2004 Sep.

Electronic copies: Available from the Chest - The Cardiopulmonary and Critical Care Journal Web site.

Print copies: Available from the American College of Chest Physicians (ACCP), Products and Registration Division, 3300 Dundee Road, Northbrook IL 60062-2348.

The following is also available:

  • Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy: Evidence-based guidelines; quick reference guide. Northbrook, IL: ACCP, 2004 Sep. Personal Digital Assistant (PDA) download available at ACCP Web site.

Additional implementation tools are also available:

  • Clinical resource: antithrombotic and thrombolytic therapy. Northbrook, IL. ACCP, 2004. Ordering information: Available from the ACCP Web site.

PATIENT RESOURCES

The following is available:

  • A patient's guide to antithrombotic and thrombolytic therapy. In: Clinical resource: antithrombotic and thrombolytic therapy. Northbrook (IL): American College of Chest Physicians (ACCP). 2004.

Ordering information is available from the ACCP Web site.

Please note: This patient information is intended to provide health professionals with information to share with their patients to help them better understand their health and their diagnosed disorders. By providing access to this patient information, it is not the intention of NGC to provide specific medical advice for particular patients. Rather we urge patients and their representatives to review this material and then to consult with a licensed health professional for evaluation of treatment options suitable for them as well as for diagnosis and answers to their personal medical questions. This patient information has been derived and prepared from a guideline for health care professionals included on NGC by the authors or publishers of that original guideline. The patient information is not reviewed by NGC to establish whether or not it accurately reflects the original guideline's content.

NGC STATUS

This summary was completed by ECRI on July 30, 2001. The information was verified by the guideline developer on October 31, 2001.This NGC summary was updated by ECRI on December 9, 2004. The updated information was verified by the guideline developer on January 12, 2005. This summary was updated by ECRI on March 6, 2007 following the U.S. Food and Drug Administration (FDA) advisory on Coumadin (warfarin sodium). This summary was updated by ECRI Institute on June 22, 2007 following the U.S. Food and Drug Administration (FDA) advisory on heparin sodium injection. This summary was updated by ECRI Institute on September 7, 2007 following the revised U.S. Food and Drug Administration (FDA) advisory on Coumadin (warfarin). This summary was updated by ECRI Institute on March 14, 2008 following the updated FDA advisory on heparin sodium injection.

COPYRIGHT STATEMENT

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.

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DISCLAIMER

NGC DISCLAIMER

The National Guideline Clearinghouse™ (NGC) does not develop, produce, approve, or endorse the guidelines represented on this site.

All guidelines summarized by NGC and hosted on our site are produced under the auspices of medical specialty societies, relevant professional associations, public or private organizations, other government agencies, health care organizations or plans, and similar entities.

Guidelines represented on the NGC Web site are submitted by guideline developers, and are screened solely to determine that they meet the NGC Inclusion Criteria which may be found at http://www.guideline.gov/about/inclusion.aspx .

NGC, AHRQ, and its contractor ECRI Institute make no warranties concerning the content or clinical efficacy or effectiveness of the clinical practice guidelines and related materials represented on this site. Moreover, the views and opinions of developers or authors of guidelines represented on this site do not necessarily state or reflect those of NGC, AHRQ, or its contractor ECRI Institute, and inclusion or hosting of guidelines in NGC may not be used for advertising or commercial endorsement purposes.

Readers with questions regarding guideline content are directed to contact the guideline developer.
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