Decision-Making in the Management of Venous Thromboembolism |
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| Authors: | Martin H Ellis Orly Avnery |
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| Institution: | 1. Hematology Institute and Blood Bank, Meir Medical Center, Kfar Saba, Israel;2. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;1. Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Santander, Spain;2. Marqués de Valdecilla Health Research Institute (IDIVAL), Santander, Spain;3. Network Center for Biomedical Research in Hepatic and Digestive Diseases (CIBERehd), Madrid, Spain;4. Radiology Department, Marqués de Valdecilla University Hospital, Santander, Spain;5. Pathological Anatomy Service, Marqués de Valdecilla University Hospital, Santander, Spain;1. Department of Medicine, Laniado Hospital, Sanz Medical Centre, Netanya, Israel;2. Faculty of Medicine, Hebrew University and Hadassah Medical School, Jerusalem, Israel;1. Sanger Heart and Vascular Institute;2. Department of Internal Medicine, Atrium Health – Carolinas Medical Center, Charlotte, NC;1. DLR-German Aerospace Center, Institute for Aerospace Medicine, Cologne, Germany;2. Department of Diagnostic and Interventional Radiology, Hannover Medical School, Germany;3. Department of Anesthesiology and Intensive Care Medicine, Merheim Medical Center, Hospitals of Cologne, University of Witten/Herdecke, Germany;4. University of Cologne, Medical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, Germany |
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| Abstract: | Venous thromboembolism comprising deep venous thrombosis and pulmonary embolus is common. Patients with venous thromboembolism may present to a variety of health care providers, and while a significant proportion of patients begin treatment in the hospital, ambulatory management of both deep venous thrombosis and pulmonary embolus is feasible and becoming more common. Initial anticoagulant management, investigation of venous thromboembolism etiology, and decisions about extended anticoagulation require coordinated care by physicians from multiple specialties. Comprehensive management of venous thromboembolism requires coordinated care from the time of presentation in order to expedite diagnosis, initiate timely anticoagulant treatment, determine the need for extended anticoagulation based on risk of bleeding and recurrent thrombosis, and advise on thromboprophylaxis during future high-risk periods for venous thromboembolism. In this review we use case scenarios to provide an operational framework, based on current evidence-based recommendations, for informed decision-making about a number of clinical practice issues that are frequently encountered in the management of venous thromboembolism patients. |
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| Keywords: | Clinical decision-making Management Venous thromboembolism |
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