Venous Thromboembolism - Management Disease Summary

Overview

Venous thromboembolism (VTE) is most commonly manifested as pulmonary embolism (PE) and deep venous thrombosis (DVT) and is associated with significant morbidity and mortality. These diseases are defined in the Introduction section.

Incidence and prevalence of VTE are stated in the Epidemiology section.

The mechanisms involved in the development of VTE per Virchow’s triad theory are discussed in the Pathophysiology section.

Provoking factors for the development of VTE may be transient/reversible or chronic/non-reversible. These as well as other risk factors are discussed in the Risk Factors section.

Classification of deep vein thrombosis (DVT) according to etiology and anatomical level are identified and discussed in the Classification section. 

History and Physical Examination

Signs and symptoms that are suggestive of DVT and pulmonary embolism are enumerated and discussed in the Clinical Presentation section.

Diagnosis

Laboratory Tests and Ancillaries and Imaging studies to be considered in patients suspected of having DVT and pulmonary embolism are discussed in these sections.

Confirmation of the diagnosis of DVT and pulmonary embolism is essential in the management of these conditions. Pretest probability is needed to guide the diagnostic process. The Diagnosis or Diagnostic Criteria section includes the Wells Scale of Clinical Pretest Probability for both DVT and pulmonary embolism, the Geneva Clinical Prediction Rule for pulmonary embolism, and the pulmonary embolism rule-out criteria (PERC).

Diseases that may present similar symptoms to DVT and pulmonary embolism and should be ruled out are in the Differential Diagnosis section.

Management

Patients with VTE are managed with thrombolytic therapy. In the Evaluation section, the absolute and relative contraindications to thrombolysis are enumerated. Prompt management of hemodynamically unstable patients is also discussed in this section.

In the Principles of Therapy section, phases of anticoagulation in DVT, general therapy principles on Heparin and anticoagulant use, and thrombolysis in pulmonary embolism are discussed in detail.

Details about the different drug options for parenteral and oral anticoagulation in the management of DVT and non-massive pulmonary embolism, thrombolysis of massive or sub-massive pulmonary embolism and prompt management of clinical instability are in the Pharmacological Therapy section.

Different Nonpharmacological options like bed rest and leg elevation, early ambulation, exercise and use of graduated elastic compression stockings are described. Patient education is also in this section.

In the Surgery section, different invasive procedures, thrombectomy and vena caval interruption that can be performed on patients with VTE are discussed.

Monitoring parameters with or without anticoagulation therapy are enumerated and discussed in this section. 

Venous Thromboembolism - Disease Summary