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Internal Medicine 101

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  1. Pneumonia 

    Community-Acquired Pneumonia
    9 Topics
    |
    3 Quizzes
  2. Venous Thromboembolic Disease
    Acute Management of Pulmonary Embolism
    12 Topics
    |
    2 Quizzes
  3. Acute Management of DVT
    10 Topics
    |
    2 Quizzes
  4. Diabetes and Hyperglycemia
    Hyperglycemia in Hospitalized Patients
    11 Topics
    |
    2 Quizzes
  5. Hyperglycemic Crisis: Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic Syndrome
    13 Topics
    |
    3 Quizzes
  6. Pulmonary Exacerbations
    Chronic Obstructive Pulmonary Disease Exacerbation
    10 Topics
    |
    3 Quizzes
  7. Asthma Exacerbation
    15 Topics
    |
    3 Quizzes

Participants 396

  • Allison Clemens
  • April
  • ababaabhay
  • achoi2392
  • adhoward1
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Lesson 3, Topic 8
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Summary and References

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The acute management of deep vein thrombosis (DVT) involves a multifaceted approach that includes identification of risk factors, accurate diagnosis, risk stratification, and pharmacological treatment. The course has provided a deep dive into these various aspects, discussing the epidemiology and pathophysiology of DVT, diagnostic modalities, anticoagulant options, interventional therapies, and the approach to special populations and complications.

Risk stratification through clinical prediction rules like the Wells score, as well as the interpretation of D-dimer test results and Doppler ultrasonography, play crucial roles in diagnosis. Anticoagulation remains the cornerstone of treatment, with several options including heparin, low molecular weight heparin (LMWH), fondaparinux, and direct oral anticoagulants (DOACs) like rivaroxaban, apixaban, and edoxaban. Transitioning between these agents and determining the appropriate duration of therapy is equally important.

References

  1. Heit JA. The epidemiology of venous thromboembolism in the community. Arterioscler Thromb Vasc Biol. 2008;28(3):370-372.
  2. Kearon C. Natural history of venous thromboembolism. Circulation. 2003;107(23 Suppl 1):I22-I30.
  3. Jaff MR, McMurtry MS, Archer SL, et al. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation. 2011;123(16):1788-1830.
  4. Konstantinides SV, Meyer G, Becattini C, et al. 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 Respir J. 2019;54(3):1901647.
  5. Roberts LN, Patel RK, Arya R. Venous thromboembolism and ethnicity. Br J Haematol. 2009;146(4):369-383.
  6. Streiff MB, Lau BD. Thromboprophylaxis in medically ill patients. Discov Med. 2014;18(100):173-180.
  7. White RH. The epidemiology of venous thromboembolism. Circulation. 2003;107(23 Suppl 1):I4-I8.
  8. Linkins LA, Dans AL, Moores LK, et al. Treatment and prevention of heparin-induced thrombocytopenia: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e495S-e530S.
  9. Ortel TL, Neumann I, Ageno W, et al. American Society of Hematology 2020 guidelines for management of venous thromboembolism: diagnosis of venous thromboembolism. Blood Adv. 2020;4(19):4693-4738.
  10. Stevens SM, Woller SC, Kreuziger LB, et al. Antithrombotic Therapy for VTE Disease: Second Update of the CHEST Guideline and Expert Panel Report. Chest. 2021;160(6):e545-e601.
  11. Schulman S, Kakkar AK, Goldhaber SZ, et al; RE-COVER II Trial Investigators. Treatment of acute venous thromboembolism with dabigatran or warfarin and pooled analysis. Circulation. 2014;129(7):764-772.
  12. Bauersachs R, Berkowitz SD, Brenner B, et al; EINSTEIN Investigators. Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med. 2010;363(26):2499-2510.
  13. Agnelli G, Buller HR, Cohen A, et al; AMPLIFY Investigators. Oral apixaban for the treatment of acute venous thromboembolism. N Engl J Med. 2013;369(9):799-808.
  14. Hokusai-VTE Investigators, Büller HR, Décousus H, et al. Edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism. N Engl J Med. 2013;369(15):1406-1415.
  15. Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. 2016;149(2):315-352.
  16. Hull RD, Pineo GF, Brant RF, et al; LITE Trial Investigators. Home therapy of venous thrombosis with long-term LMWH versus usual care: patient satisfaction and post-thrombotic syndrome. Thromb Haemost. 2009;102(1):41-48.
  17. Lee AY, Levine MN, Baker RI, et al. Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med. 2003;349(2):146-153.
  18. Agnelli G, Becattini C, Meyer G, et al; AMPLIFY-EXT Investigators. Apixaban for Extended Treatment of Venous Thromboembolism. N Engl J Med. 2013;368(8):699-708.
  19. Weitz JI, Lensing AWA, Prins MH, et al; EINSTEIN CHOICE Investigators. Rivaroxaban or Aspirin for Extended Treatment of Venous Thromboembolism. N Engl J Med. 2017;376(13):1211-1222.
  20. Douketis JD, Foster GA, Crowther MA, Prins MH, Ginsberg JS. Clinical risk factors and timing of recurrent venous thromboembolism during the initial 3 months of anticoagulant therapy. Arch Intern Med. 2000;160(22):3431-3436.
  21. Linkins LA, Choi PT, Douketis JD. Clinical impact of bleeding in patients taking oral anticoagulant therapy for venous thromboembolism: a meta-analysis. Ann Intern Med. 2003;139(11):893-900.