DVT and PE
DVT and PE are a significant national health problem, with up to 2M US cases diagnosed per year.
Anticoagulation is the gold standard for DVT treatment, though this simply reduces the possibility of PE, it does not “cure” DVT.
DVT and PE together are grouped as Venous Thromboembolism or VTE. This review notes that over 250,000 to 2,000,000 cases of VTE present in the US every year. Risk factors for DVT include immobility, smoking, obesity, hypertension, surgery, trauma, chronic medical diseases, the use of oral contraceptives and pregnancy. Due to these risk factors, clots or thrombi may form in the deep veins of the upper or lower extremity. PE may occur if these clots embolize to the pulmonary arteries.
DVT commonly presents in the upper or lower extremity with cramping, swelling and discoloration. PE commonly presents as chest discomfort, shortness of breath and/or a sense of anxiety. DVT is most often diagnosed with venous ultrasound, PE with CT scan.
DVT and PE are typically treated with anticoagulants; beginning with IV unfractionated heparin or injectable low molecular weight heparin. This is overlapped with oral warfarin until therapeutic levels are reached. Heparin administration is then stopped. Oral warfarin is continued for at least six months.
Reference: Goldhaber, SZ and Morrison, RB. Pulmonary Embolism and Deep Vein Thrombosis. Circulation 2002; 106:1436-1438.
Key Learnings:
- The occurrence of VTE in the US is high
- Confirmation of the diagnosis of DVT and/or PE is dependent upon imaging techniques
- The most common method of treatment of DVT is the use of anticoagulants to reduce the possibility of embolization and resultant PE