We rated down the certainty in the evidence for risk of bias, given that the trial was open label, and for imprecision, because the CIs around the absolute estimates include benefit and harm. The ASH guideline panel provided a strong recommendation in favor of indefinite antithrombotic therapy for secondary prevention of recurrent thromboembolism in light of the very high risk of recurrence off anticoagulation. was chair and I.N. All seven trials reported the effect of antithrombotic therapy on mortality and PE and assessed the risk of major bleeding. A longer course of therapy with a DOAC also reduced the risk of PE (RR, 0.13; 95% CI, 0.03-0.58; ARR, 21 fewer per 1000 patients; 95% CI, 24 fewer to 10 fewer for study population; ARR, 38 fewer per 1000 patients; 95% CI, 42 fewer to 18 fewer for low-risk population; moderate-certainty evidence). Please continue to hold December 5-8, 2020, on your calendar. Assuming that 45% of the VTE events are PEs and 55% are DVTs,269 we estimated the risks of PE recurrence to be 5.4 per 100 patient-years and the risks of DVT recurrence to be 6.6 per 100 patient-years for patients with recurrent unprovoked VTE. However, it should be noted that patients considered to have a “high risk of bleeding” were excluded from the randomized trial described in the analysis above.316 Decisions concerning anticoagulant therapy with warfarin for patients with a significant bleeding risk need to be individualized, and a VKA may not be the optimal anticoagulant in this setting. In such circumstances, the result of the voting was recorded on the respective EtD table. The decision to treat a patient with an isolated DVT at home needs to be individualized, and certain patients would be more appropriately treated in the hospital, including patients with massive DVT (defined as being associated with severe pain, swelling of the entire limb, phlegmasia cerulea dolens, or limb ischemia), at high risk for anticoagulant-related bleeding, or with major comorbidities.50 Social factors, such as limited home support, history of noncompliance, and limited financial resources, may also favor the hospital setting for the initial phase of treatment. In health systems with poor primary care, home treatment may reduce equity. Approximately 3% to 5% of patients with an acute PE present with hemodynamic compromise, defined as a systolic blood pressure <90 mm Hg or a decrease in systolic blood pressure ≥40 mm Hg from baseline.205,206 These patients are at a significantly greater risk for mortality, as high as 50% by 90 days,205 compared with patients with acute PE who do not present with hemodynamic compromise. See the ASH guideline on optimal anticoagulant therapy for additional details.117. The panel estimated that the cost of a DOAC does not vary significantly with the dose. Blood Adv. The panel did recognize the potential safety advantage of using a catheter-directed approach, but the imprecision of the data limited any conclusions that would favor this approach. American Society of Hematology 2020 guidelines for sickle cell disease: management of acute and chronic pain Blood Adv. Additionally, we also rated down the certainty in the evidence by inconsistency, given that 7 of the included studies reported significant PTS reduction, whereas 1 single trial (ATTRACT trial)146 reported the absence of a significant effect (I2 = 57%). In this study, participants were randomized to stop anticoagulation or to continue it for up to 18 months. Additionally, when possible, we used the baseline risk observed in large observational studies. American Society of Hematology; Meetings; ASH Annual Meeting & Exposition; ASH Annual Meeting Abstracts; Education. Patients were followed for 2 years. Clinicians must make decisions on the basis of the clinical presentation of each individual patient, ideally through a shared decision-making process that considers the patient’s values and preferences with respect to the anticipated outcomes of the chosen option.