, Benjamin Hohlfelder2 and Samuel Z. Goldhaber3
(1)
Cardiovascular Division, Harvard Medical School Brigham and Women’s Hospital, Boston, Massachusetts, USA
(2)
Department of Pharmacy Services, Brigham and Women’s Hospital, Boston, Massachusetts, USA
(3)
Thrombosis Research Group, Harvard Medical School Brigham and Women’s Hospital, Boston, Massachusetts, USA
Abstract
Venous Thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is the third most common cardiovascular disorder after myocardial infarction and stroke. VTE is a common complication of hospitalization and is the most preventable cause of death among hospitalized patients. While the majority of patients who develop VTE do so as outpatients, many have been hospitalized for medical or surgical illness within 3 months preceding the diagnosis of VTE. VTE is frequently a recurrent disease, with patients who suffer unprovoked VTE having the highest risk of future events.
Keywords
Deep vein thrombosisIncidenceMortalityPulmonary embolismVenous thromboembolismSelf-Assessment Questions
1.
A 62-year-old woman with a past medical history of hypertension and hyperlipidemia presented with acute right-sided calf pain and ankle edema. She denied any recent major trauma, major surgery, or immobility. A lower extremity venous ultrasound was performed to evaluate for deep vein thrombosis (DVT) and confirmed thrombosis of the right popliteal vein. She has no prior history of venous thromboembolism and is up-to-date with all of her age appropriate cancer screening. Which of the following statements about her risk of VTE recurrence is correct?
(a)
She has a 20 % risk of VTE recurrence over the next 10 years after completing 6 months of anticoagulation for her unprovoked DVT.
(b)
She has a 20 % risk of VTE recurrence over the next 10 years if she remains on indefinite duration anticoagulation after her unprovoked DVT.
(c)
She has a 30–50 % risk of VTE recurrence over the next 10 years after completing 6 months of anticoagulation for her unprovoked DVT.
(d)
She has a 30–50 % risk of VTE recurrence over the next 10 years if she remains on indefinite duration anticoagulation after her unprovoked DVT.
2.
Which of the following statements about the epidemiology of venous thromboembolism (VTE) is false?
(a)
Pulmonary embolism (PE) is the most preventable cause of death among hospitalized medical patients.
(b)
VTE is the third most common cardiovascular disorder after myocardial infarction and stroke.
(c)
Long-term mortality in patients who have suffered an initial VTE is similar to that of age-matched individuals from the general population.
(d)
Recurrent PE is an important cause of mortality in patients who have suffered an initial VTE.
Clinical Vignette
A 72-year-old man with prior history of right lower extremity deep vein thrombosis (DVT) following right knee arthroscopy 10 years prior developed acute pleuritic pain and dyspnea at rest while hospitalized for an exacerbation of chronic obstructive pulmonary disease. He had been prescribed venous thromboembolism (VTE) prophylaxis in the form of enoxaparin 40 mg subcutaneously daily but had been refusing the injections. Physical examination was remarkable for a resting tachycardia of 108 beats per minute, normal blood pressure of 128/62 mmHg, and hypoxemia with an oxygen saturation on room air of 88 %. He had mild left lower extremity edema. A contrast-enhanced chest computed tomogram (CT) demonstrated bilateral pulmonary embolism (PE) (Fig. 1.1). Lower extremity venous ultrasound demonstrated left common femoral DVT (Fig. 1.2).
Fig. 1.1
Contrast-enhanced chest computed tomogram (CT) demonstrating bilateral pulmonary embolism (PE) (arrows) in a 72-year-old man who developed acute pleuritic pain and dyspnea at rest during a hospitalization for chronic obstructive pulmonary disease
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