Venous Thromboembolism

Abstract

enous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common and potentially fatal disease. The estimated incidence of a first acute VTE is 0.7 to 1.4 per 1000 person-years and is mostly observed in patients older than 55 years. [1][2][3][4] While the incidence of DVT has remained constant over time, 5 hospital admissions for PE in the United States more than doubled over the last decades, 6 partly because of widespread use of sensitive imaging techniques detecting smaller, potentially insignificant emboli. 7 Even though the in-hospital case-fatality rate of PE has decreased in the United States between 1999 and 2008, 8 about 30% of patients with PE die within the first year after diagnosis. 4 The socioeconomic effect of VTE is significant, with estimated annual costs ranging from $13.5 billion to $27.2 billion in the United States. 9Clinical signs and symptoms of DVT include unilateral leg pain, redness, swelling, edema, warmth, and tenderness. Pulmonary embolism may present with dyspnea, chest pain, hemoptysis, syncope, tachycardia, and hypotension. The clinical presentation of VTE is often not specific, and DVT can be indistinguishable from cellulitis, hematoma, superficial thrombophlebitis, and congestive heart failure. Pulmonary embolism presents similarly to myocardial infarction, congestive heart failure, and other diseases. Consequently, imaging is needed to confirm the diagnosis of VTE. The diagnosis of VTE is made in a sequence of steps including assessment of the pretest probability, followed by D-dimer testing and imaging as appropriate (Figure 1). When VTE is diagnosed, immediate initiation of anticoagulant therapy is imperative. The choice among different anticoagulant agents and the duration of treatment are based IMPORTANCE Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common and potentially fatal disease.OBJECTIVE To summarize the advances in diagnosis and treatment of VTE of the past 5 years.EVIDENCE REVIEW A systematic search was conducted in EMBASE Classic, EMBASE, Ovid MEDLINE, and other nonindexed citations using broad terms for diagnosis and treatment of VTE to find systematic reviews and meta-analyses, randomized trials, and prospective cohort studies published between January 1, 2013, and July 31, 2018. The 10th edition of the American College of Chest Physicians Antithrombotic Therapy Guidelines was screened to identify additional studies. Screening of titles, abstracts, and, subsequently, full-text articles was performed in duplicate, as well as data extraction and risk-of-bias assessment of the included articles.FINDINGS Thirty-two articles were included in this review. The application of an age-adjusted D-dimer threshold in patients with suspected PE has increased the number of patients in whom imaging can be withheld. The Pulmonary Embolism Rule-Out Criteria safely exclude PE when the pretest probability is low. The introduction of direct oral anticoagulants has allowed for a simpli...

Thrombotic disorders (part 2)

“…2 outlines a diagnostic approach for suspected thrombo embolic disease. [38] Wells' scores for clinical assessment of deep-vein thrombosis and pulmonary embolism appear in Tables 4 and 5, respectively.…”

Effect of Uncaria gambir and Uncaria sclerophylla on Pulmonary- Thromboembolism Mice

“…2 The thrombi formation in deep veins itself called DVT, when DVT is released, it will travel to the lungs causing a block in blood supply called pulmonary embolism. 3 If this pathology not treated immediately the mortality will increase about 23 -73%. 4 Data reported the incidence of VTE annually ranges from 104-183 person cases per year, its similar the rate of stroke cases.…”

Clinical Applications, Pitfalls, and Uncertainties of Thrombin Generation in the Presence of Platelets

“…Thromboembolic disease and bleeding, representing two sides of the same coin, have been traditionally investigated by using different laboratory approaches. In addition to the clinical probability, D-dimers are currently the only established laboratory biomarkers routinely used to rule out venous thromboembolism (VTE) [1]. On the other hand, activated partial thromboplastin time (aPTT), prothrombin time (PT), and platelet function investigations are in clinical use for evaluating bleeding diathesis [2].…”