Venous Thromboembolism

Abstract

January 2007

Section 1 Cardiovascular Medicine

XVIII Venous Thromboembolism

Clive Kearon, M.D., Ph.D
Associate Professor of Medicine, McMaster University, and Head of the Thrombosis Service, Henderson General Hospital, Hamilton Health Sciences

Jack Hirsh, M.D., F.A.C.P.
Professor Emeritus, McMaster University, and Director, Hamilton Civic Hospitals Research Centre

Venous thromboembolism, which involves venous thrombosis and pulmonary embolism, is a leading cause of morbidity and mortality in hospitalized patients and is being seen with increasing frequency in outpatients. This chapter discusses the risk factors, etiology, classification, pathophysiology, natural history, prognosis, diagnosis (including venous thrombosis, recurrent venous thrombosis, and pulmonary embolism), prophylaxis, and treatment of venous thromboembolism (including the pharmacology of antithrombotic agents), as well as venous thromboembolism in pregnancy and miscellaneous thromboembolic disorders (including thrombosis of unusual sites). Tables in the chapter present a model for determining clinical suspicion of deep vein thrombosis, test results that effectively confirm or exclude deep vein thrombosis, a model for determining a clinical suspicion of pulmonary embolism, test results that effectively confirm or exclude pulmonary embolism, drug and food interactions with warfarin by level of supporting evidence and direction of interaction, risk categories for venous thromboembolism, and recommendations for prophylaxis. Figures include a venogram illustrating thrombi in the left iliac vein, perfusion scans showing multiple perfusion defects, a computed tomographic pulmonary angiogram demonstrating intraluminal filling defects, a diagnostic approach for suspected pulmonary embolism, and an algorithm for selecting duration of anticoagulation after venous thromboembolism. There are 105 references in this chapter.

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