Experts Offer Guidelines for Challenging Blood Clots

URMC pulmonologist R. James White, M.D., Ph.D., was among a panel of experts that helped the American Heart Association develop guidelines for caring for patients with life-threatening venous thromboembolism and the related complication of pulmonary hypertension.

“These best practices help doctors when they encounter patients with life-threatening ailments that account for more than a quarter-million hospitalizations each year,” said White, a contributing author of the guidelines. “Up until now, we haven’t had consensus recommendations for the treatment of some of these disorders and as a result, care has been highly controversial and probably suboptimal for many patients.”

R. James White, M.D., Ph.D.

R. James White, M.D., Ph.D.

The AHA issued a scientific statement for treatment of large pulmonary embolism, deep vein thrombosis, and chronic thromboembolic pulmonary hypertension. White serves on the AHA’s Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation, one of two American Heart Association councils that wrote the recommendations after reviewing scientific data. The new guidelines are available on the AHA website and were featured in Circulation: Journal of the American Heart Association.

“We all agree on how to treat common clots that are small and the very large ones. It’s the ones in between, the medium-to-large-sized embolisms, over which pulmonary doctors lose much sleep,” White said.

The guidelines review the current data and offer support for clinicians to use clot-busting drugs, like alteplase, for patients who appear well at the moment but have a high risk of dying during their initial week in the hospital.

“Moreover, for about 5 percent of patients with pulmonary embolism, the initial clot progresses to cause widespread scarring in the lung blood vessels; one of our goals in writing these guidelines was to highlight the problem of chronic thromboembolic pulmonary hypertension and point frontline physicians to the national centers where patients could get the care they need,” White said.

A patient with these medium-to-large clots typically gets the benefit of a multidisciplinary team of specialists in cardiology, pulmonology and hematology working together to develop the optimal treatment plan, weighing the risks and benefits of aggressive treatment with clot-busters. 

“In these cases, there are lots of cooks in the kitchen because, so far, we haven’t had the right recipe to care for these high-risk patients. This document provides the closest thing to a recipe that we will have until ongoing research is completed,” said White.

White leads a specialized program for pulmonary hypertension offering the most current care and opportunities to participate in clinical trials of new agents and therapies.

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