What’s new in Therapeutic Guidelines: Cardiovascular version 7?

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The March 2018 release of eTG complete includes a comprehensive update of the Cardiovascular guidelines. They emphasise individualised, patient-centred therapy to optimise the treatment and prevention of common cardiovascular conditions. 

The topic on lipid modification advises on the use of lipid-modifying drugs for the primary and secondary prevention of cardiovascular disease, including new information about high-intensity statin therapy. The section about the adverse effects of statins—including a new algorithm to guide the management of muscle symptoms—provides strategies that may enable ongoing therapy in patients who experience an adverse effect. 

The topic on blood pressure reduction steps through the long-term management of blood pressure to reduce cardiovascular disease risk. 

Evidence to guide the management of severe hypertension, including hypertensive urgency and emergency, is limited. A new dedicated topic provides a consensus-based approach to the urgent control of elevated blood pressure, including information about conditions that can cause or complicate severe hypertension. 

Use of cardiac interventions continues to advance. The management of a patient with a confirmed acute coronary syndrome, including the suitability and timing of a cardiac intervention, is based on the risk of acute mortality and of recurrent events, as outlined in a new box. Following an intervention, antithrombotic therapy is often used to reduce the risk of thrombosis; however, evidence to guide therapy after each type of intervention is limited. A new topic on antithrombotic therapy after endovascular and cardiac interventions outlines the available evidence and usual ongoing management of these patients. 

Information about the management of atrial and ventricular arrhythmias is given in a series of topics, including updated recommendations for the use of non–vitamin K antagonist oral anticoagulants (NOACs) in atrial fibrillation

Venous thromboembolism (VTE) can lead to significant morbidity and mortality, so it is vital to optimise prophylaxis in any predisposing situation. The topic on VTE prophylaxis provides recommendations about prophylaxis for patients at highest risk (in hospital and following discharge), and updated information about VTE prophylaxis in the community (e.g. for lower-limb immobilisation and long-distance travel). 

Secondary VTE prophylaxis is discussed in the topic VTE treatment, which has been revised to clarify dosage and duration of acute anticoagulant therapy for proximal deep vein thrombosis (DVT) and pulmonary embolism (PE). The section about extended anticoagulant therapy to prevent recurrence of DVT and PE includes new recommendations about low intensity anticoagulant therapy for suitable patients. 

Recommendations for anticoagulation given throughout the guideline (e.g. atrial fibrillation, VTE prophylaxis, VTE treatment) are supported by comprehensive information in the topic Anticoagulant therapy, including direction on the management of bleeding and overanticoagulation. Evidence to guide anticoagulation of obese patients is limited; a new section provides a suggested approach to dosage of dalteparin, enoxaparin and NOACs in these patients. Heparin-induced thrombocytopenia (HIT) is an uncommon but dangerous complication of heparin therapy; updated information is provided on diagnosis and recommended anticoagulant therapy to manage HIT. 

Periprocedural management of patients with cardiovascular disease requires clinical judgement, with consideration of individual patient and procedural risk factors. The topic about periprocedural management has been revised in detail, in particular to address the challenges of managing antithrombotic therapy in the periprocedural period. 

Pulmonary hypertension is an uncommon condition that is primarily managed in specialist centres. A new topic provides an overview of the classification of pulmonary hypertension and the specific and nonspecific therapies used in its management.

last updated: 
Thursday, 22 March, 2018