Journal article
An Algorithmic Approach to Management of Venous Thromboembolism
Clinical and applied thrombosis/hemostasis, Vol.23(6), pp.511-517
09/01/2017
DOI: 10.1177/1076029616652727
PMID: 27268941
Abstract
Venous thromboembolism (VTE) is associated with significant morbidity and mortality. Factors such as the presence of transient risk factors for VTE, risk of bleeding, and location of deep vein thrombosis (DVT) determine the duration of anticoagulation. Extended anticoagulation is offered to patients with unprovoked pulmonary embolism (PE) or proximal DVT and a low risk of bleeding. Anticoagulation for 3 months is advised in patients with provoked DVT or PE, high risk of bleeding, and isolated distal or upper extremity DVT. In patients with unprovoked PE or proximal DVT and a low risk of bleeding, who want to stop anticoagulation after 3 months, further risk stratification is necessary. Clinical scoring system, and thrombophilia testing otherwise not routinely performed, may be considered to measure risk of annual recurrence in such cases. Short-term anticoagulation may be considered in subsegmental PE and superficial vein thrombosis, particularly if patients are at low risk of bleeding and have persistent risk factors for recurrent VTE. In cases of catheter-associated thrombosis, the catheter need not be removed routinely, and the patient may be anticoagulated for 3 months or longer if the catheter is maintained in patients with cancer. Extensive screening for occult cancer in cases of unprovoked VTE is not beneficial. New oral anticoagulants such as apixaban, rivaroxaban, or dabigatran may be preferred to vitamin K antagonists in patients without cancer or renal failure, more so after the development of reversal agents such as idarucizumab and andexanet alfa.
Details
- Title: Subtitle
- An Algorithmic Approach to Management of Venous Thromboembolism
- Creators
- Prajwal Dhakal - Michigan State UniversityKrishna Gundabolu - University of Nebraska Medical CenterVijaya R. Bhatt - University of Nebraska Medical Center
- Resource Type
- Journal article
- Publication Details
- Clinical and applied thrombosis/hemostasis, Vol.23(6), pp.511-517
- Publisher
- Sage
- DOI
- 10.1177/1076029616652727
- PMID
- 27268941
- ISSN
- 1076-0296
- eISSN
- 1938-2723
- Number of pages
- 7
- Grant note
- Physician-Scientist Training Program Grant from the College of Medicine, University of Nebraska Medical Center
- Language
- English
- Date published
- 09/01/2017
- Academic Unit
- Hematology, Oncology, and Blood & Marrow Transplantation; Internal Medicine
- Record Identifier
- 9984359823502771
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