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An Approach To:

Vol. 21 No. 1 (2023)

Approach to: Venous Thromboembolism

DOI
https://doi.org/10.26443/mjm.v21i1.851
Submitted
February 4, 2021
Published
2022-10-06

Abstract

Venous thromboembolisms can manifest as a spectrum of diseases and complications, such as deep vein thrombosis (DVT) and pulmonary embolism (PE), as a consequence of hypercoagulability, endothelial damage and/or venous stasis. DVT can present as localized pain or heaviness, unilateral edema, dilatation of superficial nonvaricose veins, a palpable cord or Homans’s sign. Symptoms of PE include acute or worsening shortness of breath and pleuritic chest pain while physical examination may be remarkable for tachycardia and tachypnea. However, given their non-specificity, using these signs and symptoms alone allows for poor differentiation between VTE and other entities. This review will focus on a multi-step diagnostic tree allowing for evidence-based interpretation of tests following a determined pre-test probability (PTP), as per Thrombosis Canada recommendations and ASH clinical guidelines. An introduction to VTE in Pediatrics and pregnancy will also be discussed.

References

  1. Burnett B. Management of Venous Thromboembolism. Primary Care: Clinics in Office Practice. 2013;40(1):73-90.
  2. Thrombosis Canada. Deep Vein Thrombosis (DVT): Diagnosis 2020 [updated 2020/05/11. Available from: https://thrombosiscanada.ca/wp-uploads/uploads/2021/01/2.-Deep-Vein-Thrombosis-Diagnosis-11May2020.pdf.
  3. Thrombosis Canada. Pulmonary Embolism (PE): Diagnosis 2020 [updated 2020/01/14. Available from: https://thrombosiscanada.ca/wp-uploads/uploads/2021/01/4.-Pulmonary-Embolism-Diagnosis_23Jan-2020.pdf.
  4. Tritschler T, Kraaijpoel N, Le Gal G, Wells PS. Venous Thromboembolism: Advances in Diagnosis and Treatment. Jama. 2018;320(15):1583-94.
  5. American College of P. MKSAP 16 : medical knowledge self-assessment program. Philadelphia: American College of Physicians; 2012.
  6. Wells PS, Anderson DR, Rodger M, Forgie M, Kearon C, Dreyer J, et al. Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. N Engl J Med. 2003;349(13):1227-35.
  7. Wells PS, Owen C, Doucette S, Fergusson D, Tran H. Does this patient have deep vein thrombosis? JAMA. 2006;295(2):199-207.
  8. Lim W, Le Gal G, Bates SM, Righini M, Haramati LB, Lang E, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: diagnosis of venous thromboembolism. Blood Adv. 2018;2(22):3226-56.
  9. Wells PS, Anderson DR, Rodger M, Stiell I, Dreyer JF, Barnes D, et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med. 2001;135(2):98-107.
  10. van Belle A, Büller HR, Huisman MV, Huisman PM, Kaasjager K, Kamphuisen PW, et al. Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography. Jama. 2006;295(2):172-9.
  11. Kline JA, Courtney DM, Kabrhel C, Moore CL, Smithline HA, Plewa MC, et al. Prospective multicenter evaluation of the pulmonary embolism rule-out criteria Prospective multicenter evaluation of the PERC. Journal of Thrombosis and Haemostasis. 2008;6(5):772-80.
  12. Thrombosis Canada. Pulmonary Embolism (PE): Treatment 2020 [updated 2020/02/16. Available from: https://thrombosiscanada.ca/wp-uploads/uploads/2021/01/5.-Pulmonary-Embolism-Treatment-16Feb2020.pdf.
  13. Thrombosis Canada. Deep Vein Thrombosis (DVT): Treatment 2020 [updated 2020/08/05. Available from: https://thrombosiscanada.ca/wp-uploads/uploads/2021/01/3.-Deep-Vein-Thrombosis-Treatment_05August2020.pdf.
  14. Thrombosis Canada. Venous Thromboembolism: Duration of Treatment 2020 [updated 2020/01/23. Available from: https://thrombosiscanada.ca/clinicalguides/#.
  15. Shoag J, Davis JA, Corrales-Medina FF. Venous Thromboembolism in Pediatrics. Pediatr Rev. 2021;42(2):78-89.
  16. Thrombosis Canada. Pregnancy: Diagnosis of DVT and PE 2020 [updated 2020/07/10. Available from: https://thrombosiscanada.ca/wp-uploads/uploads/2021/01/42.-Pregnancy-Diagnosis-of-DVT-and-PE_10July2020.pdf.
  17. Righini M, Jobic C, Boehlen F, Broussaud J, Becker F, Jaffrelot M, et al. Predicting deep venous thrombosis in pregnancy: external validation of the LEFT clinical prediction rule. Haematologica. 2013;98(4):545-8.

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