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Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis
Published on: February 10, 2023
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Deep vein thrombosis and pulmonary embolism
Marcello Di Nisio1, Nick van Es2, Harry R Büller2
1Department of Medical, Oral and Biotechnological Sciences, Gabriele D'Annunzio University, Chieti, Italy; Department of Vascular Medicine, Academic Medical Centre, Amsterdam, Netherlands.
Lancet (London, England)
|July 5, 2016
Summary
Diagnosing venous thromboembolism (VTE) involves clinical rules and D-dimer tests. Direct oral anticoagulants are preferred treatments, with extended therapy considered for high-risk patients.
Area of Science:
- Medicine
- Cardiology
- Hematology
Background:
- Venous thromboembolism (VTE), encompassing deep vein thrombosis and pulmonary embolism, presents a significant global health challenge.
- Current diagnostic strategies for suspected VTE involve a stepwise approach combining clinical decision rules and D-dimer testing.
Purpose of the Study:
- To outline the diagnostic and management guidelines for venous thromboembolism.
- To emphasize the role of direct oral anticoagulants as first-line therapy and discuss treatment duration.
Main Methods:
- Sequential application of clinical decision rules and D-dimer testing to rule out VTE.
- Ultrasonography for suspected deep vein thrombosis and CT scans for suspected pulmonary embolism.
- Comparison of direct oral anticoagulants with vitamin K antagonists for treatment efficacy and safety.
Main Results:
- Patients with low probability of VTE and a normal D-dimer can safely avoid imaging and anticoagulation.
- Direct oral anticoagulants demonstrate a lower bleeding risk and improved usability compared to vitamin K antagonists.
- Thrombolysis is reserved for hemodynamically unstable pulmonary embolism cases.
Conclusions:
- The diagnostic pathway effectively identifies patients who can forgo further investigation and treatment.
- Direct oral anticoagulants are the preferred initial treatment for VTE.
- Anticoagulation for at least 3 months is recommended, with extended therapy considered based on individual risk assessment for recurrence versus bleeding.
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