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2278 Part XII: Hemostasis and Thrombosis Chapter 133: Venous Thrombosis 2279

the benefit for most patients with PE who do not have hypotension but 8. Falck-Yitter Y, Francis CW, Johanson NA, et al: American College of Chest Physicians.
who do have evidence of right ventricular dysfunction. Further trials Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy
are needed in this group of patients. and Prevention of Thrombosis, 9th ed: American College of Chest Physicians
Evidence-based Clinical Practice Guidelines. Chest 141(2 Suppl):e278S, 2012.
The role of thrombolytic therapy in patients with DVT is limited. 9. Nicolaides AN, Fareed J, Kakkar AK, et al: Prevention and treatment of venous throm-
Thrombolytic therapy may be indicated in patients with acute massive boembolism—International consensus statement. Int Angiol 32:111, 2013.
proximal vein thrombosis (phlegmasia cerulea dolens with impending 10. Kahn SR, Morrison DR, Cohen JM, et al: Interventions for implementation of
thromboprophylaxis in hospitalized medical and surgical patients at risk for venous
venous gangrene) or in occasional patients with extensive iliofemoral thromboembolism. Cochrane Database Syst Rev 7:CD008201, 2013.
vein thrombosis who have severe symptoms because of venous outflow 11. Lester W, Freemantle N, Begaj I, et al: Fatal venous thromboembolism associated with
obstruction. Thrombolytic therapy can be given by systemic infusion hospital admission: A cohort study to assess the impact of a national risk assessment
target. Heart 99:1734, 2013.
or catheter-directed infusion. Catheter-directed thrombolysis (CDT) is 12. Catterick D, Hunt BJ: Impact of the national venous thromboembolism risk assessment
probably effective for reducing the incidence of the postphlebitic syn- tool in secondary care in England: Retrospective population-based database study.
drome. Although it was hoped that the catheter-directed approach Blood Coagul Fibrinolysis 25:571, 2014.
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might be associated with a lower risk of major bleeding, particularly 13. Hull R, Hirsh J, Carter C, et al: Diagnostic value of ventilation-perfusion lung scanning
in patients with suspected pulmonary embolism. Chest 88:819, 1985.
intracranial bleeding, than systemic injection, comparative effectiveness 14. Turkstra F, Kuijer P, van Beck EJ, et al: Diagnostic utility of ultrasonography of leg veins
research data suggest the risks of bleeding still outweigh the benefits of in patients suspected of having pulmonary embolism. Ann Intern Med 126:775, 1997.
this approach. From a national database of more than 90,000 patients 15. PIOPED Investigators: Value of the ventilation/perfusion scan in acute pulmonary
101
embolism: Results of the Prospective Investigation of Pulmonary Embolism Diagnosis
with a principal diagnosis of proximal DVT or thrombosis involving the (PIOPED). JAMA 263:2753, 1990.
vena cava, the outcomes of the 3600 patients who received CDT with 16. Kruip M, Leclercq M, van der Heul C, et al: Diagnostic strategies for excluding pulmonary
a similar number of propensity-matched patients treated with antico- embolism in clinical outcome studies. A systematic review. Ann Intern Med 138:941, 2003.
agulation alone were compared. The CDT patients were more likely to 17. Birdwell BG, Raskob GE, Whitsett TL, et al: The clinical validity of normal compres-
sion ultrasonography in outpatients suspected of having deep venous thrombosis. Ann
have intracranial bleeding (0.9 percent vs. 0.3 percent), and transfusion Intern Med 128:1, 1998.
(11.1 percent vs. 6.5 percent), and more likely to have filter placement 18. Stevens S, Elliott CG, Chan K, et al: Withholding anticoagulation after a negative result
(34.8 percent vs. 15.6 percent) and to experience PE (17.9 percent vs. on Duplex ultrasonography for suspected symptomatic deep venous thrombosis. Ann
Intern Med 140:985, 2004.
11.4 percent). The important message from this analysis of CDT use 19. Hull R, Hirsh J, Sackett DL, et al: Clinical validity of a negative venogram in patients
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in practice is that the rate of intracranial bleeding is appreciable (0.9 per- with clinically suspected venous thrombosis. Circulation 64:622, 1981.
cent) and not sufficiently low to recommend the use of CDT for DVT, 20. Rosendaal FR: Risk factors for venous thrombosis: Prevalence, risk and interaction.
Semin Hematol 34:171, 1997.
other than exceptional circumstances such as threatened limb viability. 21. Heit JA, O’Fallon WM, Peterson TM, et al: Relative impact of risk factors for deep vein
thrombosis and pulmonary embolism: A population-based study. Arch Intern Med
INFERIOR VENA CAVA FILTER 162:1245, 2002.
22. Bezemer ID, Bare LA, Doggen CJ, et al: Gene variants associated with deep vein throm-
Insertion of an inferior vena cava filter is indicated for patients with bosis. JAMA 299:1306, 2008.
acute VTE and an absolute contraindication to anticoagulant therapy 23. Engbers MJ, Van Hylckama Vlieg A, Rosendaal F: Venous thrombosis in the elderly:
Incidence, risk factors, and risk groups. J Thromb Haemost 8:2105, 2010.
and also indicated for the rare patients who have objectively docu- 24. Hull R, Merali T, Mills A, et al: Venous thromboembolism in elderly high-risk medical
mented recurrent VTE during adequate anticoagulant therapy. patients: Time course of events and influence of risk factors. Clin Appl Thromb Hemost
Insertion of a vena cava filter is effective for preventing PE. How- 19:357, 2013.
ever, use of a permanent filter results in an increased incidence of recur- 25. Simioni P, Prandoni P, Lensing AW, et al: The risk of recurrent venous thromboembo-
lism in patients with an Arg506Gln mutation in the gene for factor V (factor V Leiden).
rent DVT 1 to 2 years after insertion (increase in cumulative incidence N Engl J Med 336:399, 1997.
at 2 years increases from 12 percent to 21 percent). Therefore, if the 26. Wells PS, Owen C, Doucette S, et al: Does this patient have deep vein thrombosis?
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indication for filter placement is transient, such as a contraindication JAMA 295:199, 2006.
to anticoagulation as the result of a temporary high risk of bleeding, a 27. Stein PD, Woodard PK, Weg JG, et al: Diagnostic pathways in acute pulmonary embo-
lism: Recommendations of the PIOPED II Investigators. Am J Med 119:1048, 2006.
retrievable vena cava filter should be used. A retrievable filter can then 28. Qaseem A, Snow V, Barry P, et al: Current diagnosis of venous thromboembolism in
be removed in the several weeks to months later, once the filter is no primary care: A clinical practice guideline from the American Academy of Family
Physicians and the American College of Physicians. Ann Fam Med 5:57, 2007.
longer required. If a permanent filter is placed, long-term anticoagulant 29. Mos IC, Douma RA, Erkens PM et al: Diagnostic outcome management study in
treatment should be given as soon as safely possible to prevent morbid- patients with clinically suspected recurrent pulmonary embolism with a structured
ity from recurrent DVT. algorithm. Thromb Res 133:1039, 2014.
30. Konstantinides SV, Torbicki A, Agnelli G, et al: Task Force for the Diagnosis and Man-
agement of Acute Pulmonary Embolism of the European Society of Cardiology (ESC)
REFERENCES endorsed by the European respiratory Society (ERS): 2014 ESC Guidelines on the diag-
nosis and management of acute pulmonary embolism. Eur Heart J 35:3033, 2014.
1. Moser KM, Lemoine JR: Is embolic risk conditioned by localization of deep venous 31. Stein P, Hull RD, Patel K, et al: D-dimer for the exclusion of acute venous thrombosis
thrombosis? Ann Intern Med 94:439, 1981. and pulmonary embolism. A systematic review. Ann Intern Med 140:589, 2004.
2. Prandoni P, Polistena P, Bernardi E, et al: Upper-extremity deep vein thrombosis. Risk 32. Bernardi E, Prandoni P, Lensing AW, et al: D-dimer testing as an adjunct to ultrasonog-
factors, diagnosis, and complications. Arch Intern Med 157:57, 1997. raphy in patients with clinically suspected deep-vein thrombosis: Prospective cohort
3. ISTH Steering Committee for World Thrombosis Day: Thrombosis: A major contribu- study. BMJ 317:1037, 1998.
tor to the global disease burden. J Thromb Haemost 12:1580, 2014. 33. Kearon C, Ginsberg J, Hirsh J: The role of venous ultrasonography in the diagnosis of sus-
4. Cohen AT, Agnelli G, Anderson FA, et al: VTE Impact Assessment Group in Europe pected deep vein thrombosis and pulmonary embolism. Ann Intern Med 129:1044, 1998.
(VITAE): Venous thromboembolism (VTE) in Europe. The number of VTE events and 34. Bernardi E, Camporese G, Buller HR, et al: Serial 2-point ultrasonography plus D-dimer
associated morbidity and mortality. Thromb Haemost 98:756, 2007. vs whole-leg color-coded Doppler ultrasonography for diagnosing suspected symptom-
5. Heit J, Cohen A, Anderson FJ: Estimated annual number of incident and recurrent, fatal atic deep vein thrombosis: A randomized controlled trial. JAMA 300:1653, 2008.
and non-fatal venous thromboembolism (VTE) events in the US. Blood 106:267A, 2005. 35. Hull RD, Carter CJ, Jay RM, et al: The diagnosis of acute, recurrent deep-vein thrombo-
6. Kahn S, Lim W, Dunn AS, et al: American College of Chest Physicians: Prevention of sis: A diagnostic challenge. Circulation 67:901, 1983.
VTE in nonsurgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 36. Prandoni P, Cogo A, Bernardi E, et al: A simple ultrasound approach for detection of
9th ed: American College of Chest Physicians Evidence-based Clinical Practice Guide- recurrent proximal-vein thrombosis vein diameter. Circulation 88:1730, 1993.
lines. Chest 141(2 Suppl):e195S, 2012. 37. Rathbun S, Whitsett T, Raskob G: Negative D-dimer to exclude recurrent deep-vein
7. Gould MK, Garcia DA, Wren SM, et al: American College of Chest Physicians: thrombosis in symptomatic patients. Ann Intern Med 141:839, 2004.
Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Ther- 38. Ten Cate-Hoek AJ, Prins MH: Management studies using a combination of D-dimer
apy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians test result and clinical probability to rule out venous thromboembolism: A systematic
Evidence-based Clinical Practice Guidelines. Chest 141(2 Suppl):e227S, 2012. review. J Thromb Haemost 3:2465, 2005.

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