Prevention and management of venous thromboembolism
Curry N., Shapiro S.
Venous thromboembolism (VTE), which comprises deep vein thrombosis (DVT) and pulmonary embolism (PE), has an incidence of about 1 per 1000 per annum, with two-thirds presenting as DVT and one-third as PE. Approximately half of VTEs are associated with hospital admissions, and hospital VTE prevention programmes are important to help reduce this risk. The case fatality of VTE is approximately 5%, but there is also major morbidity caused by post-thrombotic syndrome (PTS) of the leg and chronic thromboembolic pulmonary hypertension (CTPH). Anticoagulants are highly effective in secondary prevention, but leave the patient at risk of bleeding. The risk of recurrence is considerable and patients need to be assessed to identify those who require long-term anticoagulation as secondary prevention. This chapter covers primary VTE prevention (risk assessment and thromboprophylaxis), VTE diagnosis and acute treatment and secondary VTE prevention.