Venous thromboembolism

Venous thromboembolism Microchapters
Patient Information Deep vein thrombosis Pulmonary embolism
Overview
Classification
Epidemiology
Risk Factors
Diagnosis
Treatment Deep Vein Thrombosis Pulmonary Embolism
Prevention

Editors-in-Chief: C. Michael Gibson, M.S., M.D. Associate Editor-In-Chief: Ujjwal Rastogi, MBBS [1]

Synonyms and keywords: VTE

Diagnosis

History & Symptoms | Physical examination | Lab Tests

Electrocardiogram

ECG is important as it helps in ruling out myocardial infarction which also present with chest pain.

Chest x ray

It is more helpful in making an alternative diagnoses (Eg. pneumonia which can present with dyspnea and chest pain), than for diagnosing VTE. Xray findings are most often normal in patients with PE, It may reveal:

• Enlarged right descending pulmonary artery
• Decreased pulmonary vascularity (Westermark sign)
• Elevation of the hemidiaphragm (Hampton hump)

In case of an infarction:

• A wedge-shaped infiltrate or
• Pleural effusion might be present.

Ultrasonography

• A Doppler USG detects thrombus within a vein.
  • Normal vein:free of internal echoes, compresseble.
  • Acute DVT:internal echoes are present, non compressible vein.

With the color flow Doppler, motion and the direction of flow are assessed in a far better way.

CT

It involves the pulmonary vessels imaging by use of intravenous contrast material and is diagnosed by filling defects, which are either central or adherent to the wall.

• Advantages
  • Minimally invasive
  • Allows concurrent visualization of the parenchyma, pleura, and mediastinum.
• Limitations
  • Need for contrast
  • Dose of radiation is comparatively higher than that of other diagnostic procedures

Prophylaxis

A study involving data from 16 acute care hospitals confirmed the occurrence of VTE in patient who did not received thrombo-prophylaxis in-spite of being at risk and having no contraindication for thromboprophylaxis .

VTE occurs in approximately 50% patients undergoing major orthopedic surgery who do not receive appropriate thromboprophylaxis [2].

In post-surgical patients, following strategies have been helpful in reducing the risk of VTE:

• Change in life style.
• Healthy diet.
• Exercise.
• Decreasing body weight.
• Avoiding smoking.
• Prevention of dehydration.
• Maintaining normal blood pressure.

Following recommendations are made for patients falling into other categories :

• Patients at low risk for DVT:
  • Graduated elastic compressions.
• Bedridden patients:
  • Pneumatic compression.
• Patients in Critical Care Unit:
  • Heparins (Heparin, lmwh, unfractionated heparin)
  • Warfarin.
  • Direct thrombin inhibitor.

Treatment

• For Deep Venous Thrombosis treatment, click here
• For Pulmonary embolism treatment, click here

See also

• Venous thromboembolism: Under-recognized and under-treated
• Deep vein thrombosis
• Pulmonary embolism
• Thrombosis
• Nephrotic syndrome and risk of venous and arterial thromboembolism

References

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