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KEY CONCEPTS

KEY CONCEPTS

  • imageVTE is often associated with identifiable risk factors.

  • imageThe diagnosis of suspected VTE should be confirmed by objective testing.

  • imageDuring hospitalization, patients should receive VTE prophylaxis based on the risk factors present and the anticipated duration of risk.

  • imageInitial VTE treatment should include a rapid-acting anticoagulant.

  • imageFor VTE treatment, injectable anticoagulants should be overlapped with warfarin for at least 5 days and until the patient's international normalized ratio is ≥2.0 for at least 24 hours.

  • imageDirect oral anticoagulants (DOACs) such as rivaroxaban, apixaban, dabigatran, edoxaban, and betrixaban are a significant advancement in VTE prevention and treatment.

  • imageMost patients with uncomplicated DVT or PE can be safely treated as outpatients.

  • imageMost patients with VTE should receive 3 months of anticoagulation therapy; treatment beyond 3 months should be based on the risk of VTE recurrence and bleeding as well as patient preferences.

  • imageOptimal anticoagulant therapy management requires knowledge of pharmacologic and pharmacokinetic characteristics as well as a systematic management approach with ongoing patient education.

PATIENT CARE PROCESS

PRECLASS ACTIVITY

Preclass Engaged Learning Activity

Access the following website: https://tinyurl.com/y5qtehec and read the VTE stories of at least five different patients. These stories are useful to enhance student understanding regarding the impact of VTE and its treatment on the lives of patients and their families.

INTRODUCTION

VTE is a potentially fatal disorder and significant health problem in our aging society.1 VTE results from clot formation within the venous circulation and is manifested as deep vein thrombosis (DVT) and/or pulmonary embolism (PE) (Fig. 37-1).1 DVT is rarely fatal, but PE can result in death within minutes of symptom onset, before effective treatment can be given. Beyond the symptoms produced by the acute event, VTE complications, such as the postthrombotic syndrome and chronic thromboembolic pulmonary hypertension (CTPH), also cause substantial disability and suffering.1 Identifying VTE risk factors is important for targeting patients at high risk for VTE who would most benefit from VTE prevention strategies.2–4

Rapid and accurate diagnosis is critical to making appropriate treatment decisions when VTE is suspected.5 Optimal prevention and treatment of VTE using anticoagulant drugs requires an in-depth knowledge of their pharmacology and pharmacokinetic properties, and a comprehensive approach to patient management.6 Bleeding is a common and serious complication of anticoagulant therapy.2–4

EPIDEMIOLOGY

VTE is associated with significant global disease burden.7 The incidence rate of symptomatic first VTE is estimated at 132 per 100,000 patient-years and occurs more frequently in women (55.6%).8 When standardized by age, Asians appear to have the lowest VTE incidence (122 per 100,000 patient-years) followed by whites (191) and blacks (203).8 Recurrent VTE rates are highest in the ...

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