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Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis
Published on: February 10, 2023
Pulmonary embolism and deep vein thrombosis
Samuel Z Goldhaber1, Henri Bounameaux
1Brigham and Women's Hospital, Department of Medicine, Harvard Medical School, Cardiovascular Division, Boston, MA 02115, USA. sgoldhaber@partners.org
Lancet (London, England)
|April 13, 2012
Summary
Pulmonary embolism (PE) and deep vein thrombosis (DVT) are significant cardiovascular diseases. Early diagnosis and anticoagulation treatment are crucial for managing venous thromboembolism and preventing severe outcomes.
Area of Science:
- Cardiovascular Medicine
- Hematology
- Pulmonology
Background:
- Pulmonary embolism (PE) is a leading cause of cardiovascular death, with potential sequelae like chronic thromboembolic pulmonary hypertension.
- Venous thromboembolism (VTE) shares risk factors and pathophysiology with atherothrombosis, involving inflammation, hypercoagulability, and endothelial injury.
- Accurate diagnosis of VTE relies on clinical probability assessment, D-dimer testing, compression ultrasound for deep vein thrombosis (DVT), and chest CT for PE.
Purpose of the Study:
- To provide a comprehensive overview of pulmonary embolism and deep vein thrombosis of the legs.
- To discuss the diagnosis, risk stratification, and treatment of venous thromboembolism.
- To highlight emerging anticoagulant therapies and the underutilization of prophylaxis.
Main Methods:
- Review of current literature and clinical guidelines on venous thromboembolism.
- Discussion of diagnostic modalities including D-dimer testing, ultrasound, and CT.
- Analysis of treatment strategies, including anticoagulation, thrombolysis, embolectomy, and pharmacological prophylaxis.
Main Results:
- Anticoagulation is the cornerstone of VTE treatment, with most patients responding well.
- Risk stratification is essential for determining the need for advanced treatments like thrombolysis or embolectomy in PE patients.
- Novel oral anticoagulants offer potential advantages over traditional therapies, but prophylaxis remains underused in at-risk hospitalized patients.
Conclusions:
- Effective management of PE and DVT requires timely diagnosis and appropriate anticoagulation.
- Risk stratification guides advanced treatment decisions for pulmonary embolism.
- Improved implementation of VTE prophylaxis and adoption of new oral anticoagulants are warranted.
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