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Venous thromboembolism

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Last updated: 17th Nov 2020
Published:17th Nov 2020

What is venous thromboembolism?

The terms ‘thrombosis’ and ‘embolism’ were first used by the German physician Rudolf Virchow who demonstrated a mechanistic link between deep vein thrombosis (DVT) and pulmonary embolism (PE)1.

DVT and PE are collectively referred to as venous thromboembolism (VTE) and are both serious, underdiagnosed, and preventable medical conditions1–4. DVT occurs when a thrombus (a solid mass composed of platelets, fibrin and blood cells) forms within a deep vein of the leg, pelvis, or arm1–4. As the clot propagates, fragments may dislodge to cause a blockage in the pulmonary artery – a PE. The arterial obstruction leads to redistribution of blood flow and impairment of gas exchange within the lung1,2.  Thrombosis development is triggered by combination of blood stasis, plasma hypercoagulability and endothelial dysfunction, most often initiated in the valve pockets of large veins1.

Who is at risk of venous thromboembolism?

Globally, VTE is the third leading cause of cardiovascular death1. It has an annual incidence of 1–2 events per 1,000 person-years, with the incidence increasing to 1 event per 100 person-years in individuals older than 55 years and it is more common in men than women1. Certain factors increase the risk of VTE. These include advanced age, overweight or obese, family history of VTE, oral contraceptive use, hormone replacement therapy, surgery, hospitalisation and long-haul travel1,2.

How is venous thromboembolism diagnosed?

The most common symptoms of DVT include pain, swelling and tenderness in the affected part of the body2,3,5. Symptoms of PE include difficulty breathing, fast or irregular heartbeat, chest pain, and very low blood pressure2,3,5. A diagnosis of VTE is not always straightforward because other conditions have similar symptoms3,5. However, accurate diagnosis of VTE is essential due to the morbidity and mortality associated with missed diagnoses4,5.

How is venous thromboembolism treated?

VTE is treated with anticoagulants and thrombolytics to reduce thrombus size1,3,6. Anticoagulants are also used to reduce recurrence1. However, anticoagulant therapy is complex and associated with substantial benefits and risks6. Moving forwards, the incorporation of clinical factors and novel biomarkers will allow for more accurate prediction of VTE recurrence, thus ensuring that optimal treatment can be tailored to the individual, and subsequently improve patient outcomes.

Conditions associated with VTE

There are multiple conditions associated with an increased risk of VTE, and these include cancer (cancer-associated VTE), fibrinogen deficiency disorders, cardiovascular metabolism disorders including hypertension, and stroke. Cancer-associated venous thromboembolism (VTE) is a frequent, potentially life-threatening event that complicates cancer management. Monitoring and treatment guidelines are available for cancer associated VTE, and anticoagulants are the cornerstone of therapy for the treatment and prevention of cancer-associated thrombosis (CAT).

To find out more, navigate through our Learning Zone pages where we give an overview of VTE and provide further information on the burden of disease and treatment and prevention strategies.

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References

  1. Wolberg AS, Rosendaal FR, Weitz JI, Jaffer IH, Agnelli G, Baglin T, et al. Venous thrombosis. Nat Rev Dis Prim. 2015;1:15006.
  2. Centers for Disease Control and Prevention. Venous Thromboemboilism. https://www.cdc.gov/ncbddd/dvt/index.html (accessed October 2020).
  3. National Institute for Health and Care Excellence. Venous thromboembolic diseases: diagnosis, management and thrombophilia testing. https://www.nice.org.uk/guidance/ng158/resources/venous-thromboembolic-diseases-diagnosis-management-and-thrombophilia-testing-pdf-66141847001797 (accessed October 2020).
  4. National Institute for Health and Care Excellence. Venous thromboembolism in adults: diagnosis and management. QS29. https://www.nice.org.uk/guidance/qs29/resources/venous-thromboembolism-in-adults-diagnosis-and-management-pdf-2098554175429 (accessed October 2020).
  5. Lim W, Le Gal G, Bates SM, Righini M, Haramati LB, Lang E, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: Diagnosis of venous thromboembolism. Blood Adv. 2018;2(22):3226–3256.
  6. Witt DM, Nieuwlaat R, Clark NP, Ansell J, Holbrook A, Skov J, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: Optimal management of anticoagulation therapy. Blood Adv. 2018;2(22):3257–3291.