SHM's Clinical Quick Talks-Venous Thromboembolism

Pdf Summary

This educational summary on Venous Thromboembolism (VTE), authored by Dr. Marilyn Marshall, focuses on understanding, diagnosing, and managing VTE effectively. The pathophysiology of VTE is centered around Virchow’s Triad: hypercoagulability, endothelial injury, and venous stasis, which collectively contribute to the formation of deep vein thrombosis (DVT).<br /><br />Diagnosis involves assessing the pre-test probability through the Wells score, which incorporates clinical risk factors such as active cancer, immobilization, recent surgery, and physical exam findings like leg swelling and tenderness. Patients are stratified into low, moderate, or high probability categories to guide further testing. Compression ultrasonography is the primary diagnostic tool; if negative but suspicion persists, repeat imaging in 5-7 days is recommended.<br /><br />Complications of VTE include acute pulmonary embolism (PE), occurring in about 50% of proximal DVT cases, paradoxical embolism leading to stroke or systemic emboli via cardiac shunts, phlegmasia (a severe form of venous obstruction with risk of limb ischemia), and chronic venous insufficiency or post-thrombotic syndrome developing in up to 50% of symptomatic patients within 6 months to 2 years.<br /><br />Acute management includes anticoagulation therapy tailored to patient factors: low molecular weight heparin (LMWH) is preferred in cancer-associated DVT, unfractionated heparin (UFH) in renal impairment or bleeding risk, direct oral anticoagulants (DOACs), or vitamin K antagonists (VKAs) with heparin bridging. Treatment duration is typically three months for provoked VTE or indefinite for unprovoked cases. Advanced interventions such as catheter-directed thrombolysis or mechanical thrombectomy are considered in high-risk or extensive thrombosis. Inferior vena cava (IVC) filters are reserved for cases with contraindications or recurrent VTE despite anticoagulation and should be removed promptly when possible.<br /><br />Key clinical points emphasize the importance of recognizing the triad of risk factors, considering advanced treatments for massive or submassive PE, and cautious use of IVC filters. This guide aims to support clinicians in the diagnostic workup and management of suspected DVT and PE cases.

Asset Subtitle

Marilyn Marshall

Keywords

Venous Thromboembolism

VTE

Deep Vein Thrombosis

DVT

Pulmonary Embolism

Virchow’s Triad

Wells Score

Anticoagulation Therapy

Inferior Vena Cava Filter

Post-Thrombotic Syndrome