Summary
Definition
History and exam
Key diagnostic factors
- previous VTE, thrombophilia, malignancy, postoperative setting, trauma, and indwelling central catheter
- chronic medical conditions, paresis, increasing age, obesity, estrogen-containing birth control pills and hormone replacement therapy, varicose veins, pregnancy and up to 6 weeks postpartum, first-degree relative with a history of VTE, extended travel, and admission to intensive care
Risk factors
- previous VTE (deep vein thrombosis [DVT] and/or pulmonary embolism [PE])
- thrombophilia
- malignancy
- postoperative setting
- trauma
- indwelling central catheter (upper or lower extremity)
- immobility
- myeloproliferative diseases
- congestive heart failure
- chronic obstructive pulmonary disease
- inflammatory bowel disease (IBD)
- neurologic disease with extremity paresis
- increasing age
- obesity
- estrogen-containing birth control pills, hormone replacement therapy (HRT), and androgen deprivation therapy
- history of varicose veins
- pregnancy/postpartum
- extended travel
- lower leg immobility
- first-degree relative with a history of VTE
- admission to intensive care
Diagnostic tests
1st tests to order
- CBC
- serum creatinine
- INR
- PTT
Tests to consider
- serum antiplatelet factor 4 antibodies
Treatment algorithm
all at-risk patients
trauma patients
surgical patients
medical patients
Contributors
Authors
Anna L. Parks, MD
Assistant Professor
Division of Hematology
University of Utah
Salt Lake City
UT
Disclosures
ALP declares that she has no competing interests.
Acknowledgements
Dr Anna L. Parks would like to gratefully acknowledge Dr Nathalie Routhier, Dr Vicky Tagalakis, Dr Farah Zarka, Dr Vincent Bouchard-Dechêne, and Dr Adi J. Klil-Drori, previous contributors to this topic.
Disclosures
NR, FZ, VBD, and AJKD declare no competing interests. VT has received honoraria from BMS Pfizer and Bayer. She has developed educational materials for Thrombosis Canada. VT is an author of references cited in this topic.
Peer reviewers
Andrew Parfitt, MBBS, FFAEM
Clinical Director
Acute Medicine
Associate Medical Director
Consultant Emergency Medicine
Guy's and St Thomas' NHS Foundation Trust
Clinical Lead and Consultant
Accident Emergency Medicine
St Thomas' Hospital
London
UK
Disclosures
AP declares that he has no competing interests.
Sudeep Shivakumar, MD
Hematologist
Thrombosis Fellow
University of Ottawa
Ottawa Health Research Institute
Ottawa
Canada
Disclosures
SS declares that he has no competing interests.
Guidelines
- NCCN clinical practice guidelines in oncology: cancer-associated venous thromboembolic disease
- Venous thromboembolism in cancer patients: ESMO clinical practice guideline
More GuidelinesPatient information
Deep vein thrombosis
DVT and long-distance travel
More Patient informationVideos
Venepuncture and phlebotomy: animated demonstration
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