[Which tests should be performed after phlebitis and/or pulmonary embolism?]

Area of Science:

• Hematology
• Oncology
• Clinical Medicine

Context:

• Venous thrombosis (VT) diagnosis presents challenges due to poorly understood etiologies.
• Existing clinical guidelines restrict extensive etiological investigations for VT.
• The cost-effectiveness and patient benefit of exhaustive VT workups remain uncertain.

Purpose:

• To evaluate the necessity and efficacy of systematic etiological investigations in venous thrombosis.
• To discuss the impact of emerging biological data on VT diagnostic protocols.
• To assess the clinical utility of screening for occult malignancies in VT patients.

Summary:

• Current understanding of venous thrombosis origins is limited, causing clinical uncertainty.
• While some studies suggest potential causes like coagulation disorders or hidden cancers, their systematic investigation is not proven beneficial or cost-effective.
• New findings on activated protein C resistance in VT cases may necessitate revised diagnostic guidelines, but the value of extensive cancer screening is questionable.

Impact:

• This review may inform updated clinical practice guidelines for venous thrombosis diagnosis.
• Highlights the need for evidence-based approaches to etiological workups in VT.
• Emphasizes the balance between diagnostic thoroughness and resource optimization in managing venous thrombosis.