Chapter 26 - How do I handle deep vein thrombosis and acute pulmonary embolism from A to Z?

Abstract

Venous thromboembolism (VTE) manifesting as deep venous thrombosis (DVT), pulmonary embolism (PE), or both occurs in 1–2 people per 1000 annually and is the most preventable cause of death in hospitalized patients in the western world. Although independent risk factors and predictors for VTE have been identified, its occurrence is generally increasing, despite primary and secondary prophylaxis being available. Anticoagulation was and remains the standard of care for treatment, preventing DVT or PE extension or recurrence. Anticoagulation, however, does not dissolve thrombus, but rather prevents its extension while intrinsic thrombolytic pathways are slowly taking over. Eventually, a sizable proportion of survivors of acute DVT or PE are likely to suffer from postthrombotic syndrome (PTS), recurrent VTE, or late PE sequalae including chronic thromboembolic pulmonary hypertension. Given the limitations of medical therapy, catheter-directed interventions for acute iliofemoral DVT have been increasingly used over the past two decades targeting severe acute symptomatology and PTS prevention or reduction of its severity. The gained knowledge from DVT interventions has been more recently transferred to the PE field as a safer (compared to surgical thrombectomy or systemic thrombolytics) way to prevent decompensation to a higher risk PE, to decrease mortality and potentially mitigate chronic PE manifestations.