European Society for Vascular Surgery (ESVS) 2021 Clinical ...

1 Eur J Vasc Endovasc Surg (xxxx) xxx, xxx Clinical PRACTICE GUIDELINE DOCUMENT. European Society for Vascular Surgery ( esvs ) 2021 clinical practice guidelines on the management of Venous Thrombosis5. Stavros K. Kakkos *,a,y, Manjit Gohel a,y, Niels Baekgaard a, Rupert Bauersachs a, Sergi Bellmunt-Montoya a, Stephen A. Black a, Arina J. ten Cate-Hoek a, Ismail Elalamy a, Florian K. Enzmann a, George Geroulakos a, Anders Gotts ter a, Beverley J. Hunt a, Armando Mansilha a, Andrew N. Nicolaides a, Per Morten Sandset a, Gerard Stansby a esvs guidelines Committee b, Gert J.

2 De Borst, Frederico Bastos Gon alves, Nabil Chakf , Robert Hinchliffe, Philippe Kolh, Igor Koncar, Jes S. Lindholt, Riikka Tulamo, Christopher P. Twine, Frank Vermassen, Anders Wanhainen Document reviewers c, Marianne G. De Maeseneer, Anthony J. Comerota, Peter Gloviczki, Marieke Kruip, Manuel Monreal, Paolo Prandoni, Melina Vega de Ceniga DEDICATION. These guidelines are dedicated to the memory of Dr Clive Kearon of McMaster University in Hamilton, Ontario, Canada. Dr Kearon extensively reviewed the rst and second versions of the manuscript and he was always very punctual.

3 In the rst review round he submitted a review of 16 pages with many detailed and helpful comments. Unaware of his illness, we invited him to review the nal version of the guidelines on June 2, 2020, but sadly he passed away one day later, on June 3, 2020. We will always remember Dr Kearon for his many contributions to the eld of Thrombosis and Antithrombotic Treatment, including these guidelines . Clive Kearon, 1957e2020. (picture reproduced with permission from Weitz JI & Bates SM. Obituary for Dr. Clive Kearon. J Thromb Haemost. 2020;18:2783e2784). 5.

4 For a full list of the authors' af liations, please refer to Appendix. a Writing Committee: Stavros K. Kakkos (chair; Patras, Greece)y, Manjit Gohel (co-chair; Cambridge and London, UK)y, Niels Baekgaard (Copenhagen, Denmark), Rupert Bauersachs (Darmstadt, Germany), Sergi Bellmunt-Montoya (Barcelona, Spain), Stephen A. Black (London, UK), Arina J. ten Cate-Hoek (Maastricht, The Netherlands), Ismail Elalamy (Paris, France, and Moscow, Russia), Florian K. Enzmann (Salzburg, Austria), George Geroulakos (Athens, Greece), Anders Gotts ter (Malm , Sweden), Beverley J.

5 Hunt (London, UK), Armando Mansilha (Porto, Portugal), Andrew N. Nicolaides (London, UK, and Nicosia, Cyprus), Per M. Sandset (Oslo, Norway), and Gerard Stansby (Newcastle upon Tyne, UK). b esvs guidelines Committee: Gert J. de Borst (chair; Utrecht, The Netherlands), Frederico Bastos Gon alves (Lisbon, Portugal), Nabil Chakf (Strasbourg, France), Robert Hinchliffe (Bristol, UK), Philippe Kolh (Liege, Belgium), Igor Koncar (Belgrade, Serbia), Jes S. Lindholt (Odense, Denmark), Riikka Tulamo (Helsinki, Finland), Christopher P. Twine (Bristol, UK), Frank Vermassen (Ghent, Belgium), and Anders Wanhainen (Uppsala, Sweden).

6 C Document reviewers: Marianne G. De Maeseneer (Rotterdam, The Netherlands), Anthony J. Comerota (Alexandria, VA, USA), Peter Gloviczki (Rochester, MN, USA); Marieke Kruip (Rotterdam, The Netherlands); Manuel Monreal (Badalona and Murcia, Spain); Paolo Prandoni (Bologna, Italy), Melina Vega de Ceniga (Galdakao and Barakaldo, Spain). y These authors contributed equally. * Corresponding author. E-mail address: (Stavros K. Kakkos). 1078-5884/ 2020 Published by Elsevier on behalf of European Society for Vascular Surgery . Please cite this article as: Kakkos SK et al.

7 , European Society for Vascular Surgery ( esvs ) 2021 clinical practice guidelines on the management of Venous Thrombosis, Eur J Vasc Endovasc Surg 2020, 2 Stavros K. Kakkos et al. TABLE OF CONTENTS. List of abbreviations .. 4. 1. General aspects ..5. Purpose and methods of these guidelines ..5. Methodology ..6. Strategy for creating guidelines ..6. Literature search and selection ..6. Weighing the evidence ..6. The patient's perspective ..7. 2. Lower extremity venous thrombosis ..7. Introduction ..7. Epidemiology and burden of the disease ..7. Risk factors.

8 7. Pathophysiology of deep vein thrombosis ..7. Clinical manifestations of deep vein thrombosis ..8. Health economics of deep vein thrombosis ..8. Diagnosis and investigation ..8. Diagnosis of deep vein thrombosis and imaging strategies ..8. Clinical assessment and pre-test probability score ..8. D dimer measurement ..8. Ultrasound ..9. Computed tomography venography ..9. Magnetic resonance venography .. 10. Venography .. 10. Classification of deep vein thrombosis .. 10. Anatomical level .. 10. Aetiological classification .. 11. Investigation for pulmonary embolism.

9 11. Investigation for malignancy .. 12. Testing for hereditary and acquired thrombophilias .. 12. Details of thrombophilias and thrombophilia testing .. 12. Hereditary antithrombin, protein C, and protein S deficiency .. 13. Factor V Leiden .. 13. Prothrombin G20210A variant .. 13. Other hereditary associations .. 13. Antiphospholipid syndrome .. 13. Paroxysmal nocturnal haemoglobinuria .. 14. Whether to test for thrombophilias .. 14. Timing and details of thrombophilia tests .. 14. Treatment of deep vein thrombosis: anticoagulation .. 15. Phases of anticoagulation for deep vein thrombosis.

10 15. Anticoagulation mechanisms of action .. 15. Anticoagulant properties and dosing for the treatment of venous thrombosis .. 15. Unfractionated heparin .. 15. Low molecular weight heparins .. 16. Fondaparinux .. 16. Dabigatran .. 16. Edoxaban .. 17. Apixaban .. 17. Rivaroxaban .. 17. Bleeding and other adverse events .. 18. Risk assessment .. 18. management of bleeding in patients on anticoagulation .. 18. Unfractionated heparin reversal .. 19. Low molecular weight heparin reversal .. 19. Dabigatran reversal with idarucizumab .. 19. Factor Xa inhibitor reversal with andexanet alpha.