Venous thromboembolism: diagnosis and management of deep venous thrombosis

Abstract

Venous thromboembolism (VTE) affects 1–2 per 1000 people in the general population each year. Clinical diagnosis of deep venous thrombosis (DVT) is unreliable, and must be confirmed by compression ultrasonography or venography. A low clinical pretest probability of DVT and negative D‐dimer result reliably exclude the diagnosis, with no need for diagnostic imaging. Initial treatment of DVT is with low‐molecular‐weight heparin or unfractionated heparin for at least 5 days, followed by warfarin (target INR, 2.0–3.0) for at least 3 months. A vena cava filter is indicated in patients who are ineligible for anticoagulant therapy or who experience embolism despite therapeutic anticoagulation. Thrombolysis or surgical embolectomy may be used as a limb‐saving measure in patients with extensive proximal DVT and circulatory compromise that threatens the viability of the leg. Decisions regarding the optimal duration of anticoagulation to prevent recurrent VTE should be individualised and balance the risk of recurrence if warfarin is stopped against the risk of major bleeding and inconvenience of continuing treatment. The risk of recurrence is highest in people with recurrent unprovoked DVT or chronic predisposing factors (eg, cancer) who require indefinite anticoagulant treatment.

Thromboembolism in active ulcerative colitis

“…In the acute setting, anticoagulation with unfractionated heparin or low-molecular-weight heparin is recommended, with the eventual transition to oral anticoagulation 22. As always, the risk of bleeding must be considered when initiating patients on anticoagulant therapy.…”

Mutation Screening of the AT-III Gene in Pregnant and Post-Partum Women With Venous Thromboembolism by DHPLC

“…7 The incidence of DVT also increased by 3-to 16-fold after cesarean section when compared with vaginal delivery. 8 Venous thromboembolism most likely results from multigenic events as well as environmental factors and individual susceptibility factors. Antithrombin deficiency is 1 of the hereditary risk factors for VTE.…”

Duration of anticoagulant therapy for venous thromboembolism

“…The sequelae of VTE include death, post‐thrombotic syndrome, chronic pulmonary thromboembolic disease and recurrent VTE. Anticoagulation with an oral vitamin K antagonist (warfarin), overlapped for the first 5–7 days with unfractionated heparin, low‐molecular‐weight heparin or fondaparinux, prevents thrombus progression and reduces the risk of recurrent VTE and death during the acute phase 2 , 3 . When treatment is continued beyond the acute phase, warfarin reduces the risk of recurrent VTE but increases the risk of bleeding and requires frequent laboratory monitoring, which is inconvenient for patients.…”