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A systematic search of the medical literature was performed on June 18, 2007. The search, limited to human subjects and journals in English language, included the National Guidelines Clearinghouse, the Cochrane database, PubMed, and UpToDate®.

Deep vein thrombosis (DVT) and pulmonary embolus (PE) are some of the most common causes of excess morbidity and mortality in medicine today, yet it may be reduced with careful application of strategies, including increased venous circulation, early ambulation and anticoagulant medication. DVT and PE incidences are difficult to estimate since most episodes of thromboembolism are occult and recanalization occurs spontaneously. However, estimates suggest that approximately 600,000 cases occur in the United States annually with increases noted as the population ages.1 Worldwide estimates suggest that the incidence of venous thromboembolism (VTE) ranges from 1.22 to 1.8 per 1000 person-years.2,3 Thromboembolism is common in patients with malignancy, serious infections, serious trauma, and surgery and has a higher incidence in patients with inherited thrombophilias.4 Mortality from pulmonary embolism has been predicted to range from 1% to 8% with an estimated mortality rate of more than 15% within the first 3 months of diagnosis.5,6 Risk of recurrent VTE during the first year is as high as 5% to 10%, and thereafter the risk decreases to 2% to 3% annually.7 Morbidity complications from VTE include postthrombotic syndrome, pain, leg swelling, dermatitis ulcers, hyperpigmentation, lipodermatosclerosis, and venous gangrene.8

Because of the burden of disease associated with DVT and PE, many risk factors have been identified (Tables 39-1 and 39-2) that are associated with thromboembolisms. Risk factor stratification and strategies to prevent thromboembolism have also been developed. This chapter will focus on evaluation and management of thromboembolism in the primary care setting.

Table 39-1. Risk Factors for DVT and PE
Table 39-2. Inherited Hypercoagulable States

There are several presentations of VTE, including those in peripheral veins and those in the pulmonary vasculature (see Table 39-3). In the lower extremities where most DVTs originate, there may be diffuse pain, pain localized in the affected area, or no pain at all, similarly, there may be diffuse swelling of the extremity or none, leading to a wide differential diagnosis (Table 39-4). ...

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