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
Nathalie Routhier, MD, MSc, FRCPC
Attending Physician
Assistant Professor
University of Montreal
Montreal
Canada
Disclosures
NR declares that she has no competing interests.
Vicky Tagalakis, MD, FRCPC, MSC
![Vicky Tagalakis](/api/image/1087/en-us/normal/1087-auth-2_default.jpg)
Associate Professor
General Internal Medicine Program Director
McGill University Division of Internal Medicine
Centre for Clinical Epidemiology of the Lady Davis Institute for Medical Research
Jewish General Hospital
Montreal
Canada
Disclosures
VT declares that she 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.
Farah Zarka,
Vasculitis Clinic
Department of Medicine
Hôpital du Sacré-Coeur de Montréal
University of Montreal
Montreal,
Canada
Disclosures
FZ declares that she has no competing interests.
Acknowledgements
Dr Nathalie Routhier, Dr Vicky Tagalakis and Dr Farah Zarka would like to gratefully acknowledge Dr Vincent Bouchard-Dechêne and Dr Adi J. Klil-Drori, previous contributors to this topic.
Disclosures
VBD and AJKD declare no competing interests.
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
- Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO guideline update
- Venous thromboembolism in cancer patients: ESMO clinical practice guideline
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