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      Delphi Consensus on Reporting Standards in Clinical Studies for Endovascular Treatment of Acute Iliofemoral Venous Thrombosis and Chronic Iliofemoral Venous Obstruction

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          Abstract

          Acute iliofemoral deep vein thrombosis and chronic iliofemoral venous obstruction cause substantial patient harm and are increasingly managed with endovascular venous interventions, including percutaneous mechanical thrombectomy and stent placement. However, studies of these treatment elements have not been designed and reported with sufficient rigor to support confident conclusions about their clinical utility. In this project, the Trustworthy consensus-based statement approach was utilized to develop, via a structured process, consensus-based statements to guide future investigators of venous interventions. Thirty statements were drafted to encompass major topics relevant to venous study description and design, safety outcome assessment, efficacy outcome assessment, and topics specific to evaluating percutaneous venous thrombectomy and stent placement. Using modified Delphi techniques for consensus achievement, a panel of physician experts in vascular disease voted on the statements and succeeded in reaching the predefined threshold of >80% consensus (agreement or strong agreement) on all 30 statements. It is hoped that the guidance from these statements will improve standardization, objectivity, and patient-centered relevance in the reporting of clinical outcomes of endovascular interventions for acute iliofemoral deep venous thrombosis and chronic iliofemoral venous obstruction in clinical studies and thereby enhance venous patient care.

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          Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients.

          Summary. A variety of definitions of major bleeding have been used in published clinical studies, and this diversity adds to the difficulty in comparing data between trials and in performing meta-analyses. In the first step towards unified definitions of bleeding complications, the definition of major bleeding in non-surgical patients was discussed at the Control of Anticoagulation Subcommittee of the International Society on Thrombosis and Haemostasis. Arising from that discussion, a definition was developed that should be applicable to studies with all agents that interfere with hemostasis, including anticoagulants, platelet function inhibitors and fibrinolytic drugs. The definition and the text that follows have been reviewed and approved by the cochairs of the subcommittee and the revised version is published here. The intention is to also seek approval of this definition from the regulatory authorities.
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            WFH Guidelines for the Management of Hemophilia, 3rd edition

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              American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism

              Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), occurs in ∼1 to 2 individuals per 1000 each year, corresponding to ∼300 000 to 600 000 events in the United States annually. These evidence-based guidelines from the American Society of Hematology (ASH) intend to support patients, clinicians, and others in decisions about treatment of VTE. ASH formed a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline development process, including updating or performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and adult patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence and make recommendations, which were subject to public comment. The panel agreed on 28 recommendations for the initial management of VTE, primary treatment, secondary prevention, and treatment of recurrent VTE events. Strong recommendations include the use of thrombolytic therapy for patients with PE and hemodynamic compromise, use of an international normalized ratio (INR) range of 2.0 to 3.0 over a lower INR range for patients with VTE who use a vitamin K antagonist (VKA) for secondary prevention, and use of indefinite anticoagulation for patients with recurrent unprovoked VTE. Conditional recommendations include the preference for home treatment over hospital-based treatment for uncomplicated DVT and PE at low risk for complications and a preference for direct oral anticoagulants over VKA for primary treatment of VTE.
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                Author and article information

                Contributors
                Journal
                Circ Cardiovasc Interv
                Circ Cardiovasc Interv
                HCV
                Circulation. Cardiovascular Interventions
                Lippincott Williams & Wilkins (Hagerstown, MD )
                1941-7640
                1941-7632
                21 June 2023
                July 2023
                : 16
                : 7
                : e012894
                Affiliations
                [1]Washington University School of Medicine, St. Louis, MO (S.V.).
                [2]Mayo Clinic, Rochester, MN (P.G.).
                [3]University Hospitals Cleveland Medical Center, OH (T.L.C.).
                [4]EBQ Consulting, LLC, Northbrook, IL (S.Z.).
                [5]University of California, San Francisco (P.A.S.).
                [6]MedStar Georgetown University Hospital, Washington, DC (S.S.S.).
                [7]OhioHealth Heart and Vascular, Riverside Methodist Hospital, Columbus (R.K.).
                Author notes
                Correspondence to: Suresh Vedantham, MD, Washington University School of Medicine, 510 South Kingshighway Blvd, St. Louis, MO 63110. Email vedanthams@ 123456wustl.edu
                Author information
                https://orcid.org/0000-0002-5734-7553
                https://orcid.org/0000-0003-3934-4452
                https://orcid.org/0000-0002-4374-7513
                Article
                00010
                10.1161/CIRCINTERVENTIONS.123.012894
                10348641
                37340977
                79f3eac7-8780-4a9a-a548-398b5492e551
                © 2023 The Authors.

                Circulation: Cardiovascular Interventions is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc. This is an open access article under the terms of the Creative Commons Attribution Non-Commercial-NoDerivs License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited, the use is noncommercial, and no modifications or adaptations are made.

                History
                : 12 January 2023
                : 9 May 2023
                Categories
                10021
                10153
                10162
                10194
                10195
                Special Report
                Custom metadata
                TRUE
                T

                humans,physicians,stents,thrombectomy,thrombosis
                humans, physicians, stents, thrombectomy, thrombosis

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