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Friday, July 13, 2012

Three cheers to Dr.RW for his summary review of New ACCP Thrombosis guidelines

The current edition of the ACCP guidelines is big and filled with much that is important. I thank Dr. RW Donnell ( aka the blogger, Dr RW) for his review of this imposing document. ( So I don't have to).See here. See here for an executive summary of the 9th edition of the ACCP recommendations.

First let me echo his concern for the downplaying of subject matter experts in formulating a set of guidelines while emphasizing the role of "methodologists. I believed that one of the strengths of the ACCP efforts in this regard was the inclusion of both since the context that subject matter experts bring to the committee table is critical. Sometimes subject matter experts can mitigate the enthusiasm of the methodologist to make too much of a single RCT that might not seem to conform with clinical experience or generally accepted pathophysiological reasoning. If we could give recommendations based on a single or a small RCT we would be recommending homeopathy for various things

Here are some bits that caught my interest:

If INR is above 3: If no bleeding and INR less than or equal to 10, no treatment, if Over 10 and no bleeding give oral vitamin K.

INR can be checked as infrequently as every three months.

Avoid quinolones for out patient on warfarin due to interaction.In hospitalized patient, can use quinolones with frequent monitoring of INR.

Anti-coagulation not recommended for knee arthroscopy.

Two years of compression stocking for DVT. The frequency of this actually happening must be very low.

There is much more in Dr. RW's summary and much much more in the actual document.

1 comment:

R. W. Donnell said...

Thanks, as always, for your support and encouragement. I plan to do a series of these and just posted another one this afternoon.