Abstract
This section describes the diagnosis, risk stratification, and current treatment guidelines for venous thromboembolism (VTE) which includes both pulmonary embolism (PE) and deep vein thrombosis (DVT). The chapter focuses on considerations for outpatient treatment of VTE, including extended anticoagulation and evaluation of risk factors for recurrence.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Abbreviations
- aPTT:
-
Activated partial thromboplastin time
- AHA:
-
American Heart Association
- BNP:
-
Brain natriuretic peptide
- CTPA:
-
Computed tomography pulmonary angiogram
- CTPH:
-
Chronic thromboembolic pulmonary hypertension
- DVT:
-
Deep vein thrombosis
- ESC:
-
European Society of Cardiology
- IFDVT:
-
Iliofemoral DVT
- LMWH:
-
Low molecular weight heparin
- DOAC:
-
Direct oral anticoagulants
- PE:
-
Pulmonary embolism
- PTP:
-
Pretest probability
- PTS:
-
Post-thrombotic syndrome
- VKA:
-
Vitamin K antagonists
- V/Q:
-
Ventilation perfusion scan
- VTE:
-
Venous thromboembolism
References
Ortel TL, Neumann I, Ageno W, et al. American Society of Hematology 2020 Guidelines for Management of Venous Thromboembolism: Treatment of Deep Vein Thrombosis and Pulmonary Embolism. Blood Adv. 2020;4(19):4693–738.
Kearon C, Ageno W, Cannegieter SC, Cosmi B, Geersing G-J, Kyrle PA. Categorization of patients as having provoked or unprovoked venous thromboembolism: guidance from the SSC of ISTH. J Thromb Haemost. 2016;14(7):1480–3.
Lim W, Le Gal G, Bates S, Righini M, Haramati L, 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.
Stein P, Fowler S, Goodman L, Gottschalk A, Hales C, Hull R, et al. Multidetector computed tomography for acute pulmonary embolism. N Engl J Med. 2006;354(22):2317–27.
Righini M, Van Es J, Den Exter PL, et al. Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism: the ADJUST-PE study. JAMA. 2014;311(11):1117–24.
Furlan A, Aghayev A, Chang C, et al. Short-term mortality in acute pulmonary embolism: clot burden and signs of right heart dysfunction at CT pulmonary angiography. Radiology. 2012;265(1):283–93.
Konstantinides S, Geibel A, Kasper W, Olschewski M, Blümel L, Just H. Patent foramen ovale is an important predictor of adverse outcome in patients with major pulmonary embolism. Circulation. 1998;97(19):1946–51.
Stavros V Konstantinides, Guy Meyer, Cecilia Becattini, et al. ESC Scientific Document Group, 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Heart J. 2020;4(4):543–603.
Kearon C, Akl E, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, et al. Antithrombotic therapy for VTE disease. Chest. 2016;149(2):315–52.
Jaff M, McMurtry M, Archer S, Cushman M, Goldenberg N, Goldhaber S, et al. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension. Circulation. 2011;123(16):1788–830.
Barco S, Schmidtmann I, Ageno W, Bauersachs RM, Becattini C, Bernardi E, et al. Early discharge and home treatment of patients with low-risk pulmonary embolism with the oral factor Xa inhibitor rivaroxaban: an international multicentre single-arm clinical trial. Eur Heart J. 2019;
Mismetti P, Laporte S, Pellerin O, Ennezat P, Couturaud F, Elias A, et al. Effect of a retrievable inferior vena cava filter plus anticoagulation vs anticoagulation alone on risk of recurrent pulmonary embolism. JAMA. 2015;313(16):1627.
Stevens SM, Woller SC, Bauer KA, et al. Guidance for the evaluation and treatment of hereditary and acquired thrombophilia. J Thromb Thrombol. 2016;41(1):154–64.
Pengo V, Lensing A, Prins M, Marchiori A, Davidson B, Tiozzo F, et al. Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med. 2004;350(22):2257–64.
Douketis J, Crowther M, Foster G, Ginsberg J. Does the location of thrombosis determine the risk of disease recurrence in patients with proximal deep vein thrombosis? Am J Med. 2001;110(7):515–9.
Kahn S. Determinants and time course of the postthrombotic syndrome after acute deep venous thrombosis. Ann Int Med. 2008;149(10):698.
Mazzolai L, Aboyans V, Ageno W, et al. Diagnosis and management of acute deep vein thrombosis: a joint consensus document from the European Society of Cardiology working groups of aorta and peripheral vascular diseases and pulmonary circulation and right ventricular function. Eur Heart J. 2018;39(47):4208–18.
Ageno W, Squizzato A, Wells PS, et al. The diagnosis of symptomatic recurrent pulmonary embolism and deep vein thrombosis: guidance from the SSC of the ISTH. J Thromb Haemost. 2013;11(8):1597–602.
Vedantham S, Goldhaber S, Julian J, Kahn S, Jaff M, Cohen D, et al. Pharmacomechanical catheter-directed thrombolysis for deep-vein thrombosis. N Engl J Med. 2017;377(23):2240–52.
Cosmi B, Legnani C, Tosetto A, et al. PROLONG Investigators (on behalf of Italian Federation of Anticoagulation Clinics). Usefulness of repeated D-dimer testing after stopping anticoagulation for a first episode of unprovoked venous thromboembolism: the PROLONG II prospective study. Blood. 2010;115(3):481–8.
Hamadah A, Alwasaidi T, LE Gal G, et al. Baseline imaging after therapy for unprovoked venous thromboembolism: a randomized controlled comparison of baseline imaging for diagnosis of suspected recurrence. J Thromb Haemost. 2011;9(12):2406–10.
Schulman S. How I treat recurrent venous thromboembolism in patients receiving anticoagulant therapy. Blood. 2017;129(25):3285–93.
Brown JD, Goodin AJ, Lip GYH, et al. Risk stratification for bleeding complications in patients with venous thromboembolism: application of the HAS-BLED bleeding score during the first 6 months of anticoagulant treatment. J Am Heart Assoc. 2018;7(6)
Heit JA, Mohr DN, Silverstein MD, et al. Predictors of recurrence after deep vein thrombosis and pulmonary embolism: a population-based cohort study. Arch Intern Med. 2000;160(6):761–8.
Baglin T, Luddington R, Brown K, Baglin C. Incidence of recurrent venous thromboembolism in relation to clinical and thrombophilic risk factors: prospective cohort study. Lancet. 2003;362(9383):523–6.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Wang, S., Kempton, C. (2022). Pulmonary Embolism and DVT. In: Bhargava, A.A., Wells, B.J., Quintero, P.A. (eds) Handbook of Outpatient Cardiology . Springer, Cham. https://doi.org/10.1007/978-3-030-88953-1_22
Download citation
DOI: https://doi.org/10.1007/978-3-030-88953-1_22
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-88952-4
Online ISBN: 978-3-030-88953-1
eBook Packages: MedicineMedicine (R0)