Venous Thromboembolism: Advances in Diagnosis and Treatment.

Tritschler, Tobias; Kraaijpoel, Noémie; Le Gal, Grégoire; Wells, Philip S (2018). Venous Thromboembolism: Advances in Diagnosis and Treatment. JAMA : the journal of the American Medical Association, 320(15), pp. 1583-1594. American Medical Association 10.1001/jama.2018.14346

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Importance Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common and potentially fatal disease. Objective To summarize the advances in diagnosis and treatment of VTE of the past 5 years. Evidence Review A systematic search was conducted in EMBASE Classic, EMBASE, Ovid MEDLINE, and other nonindexed citations using broad terms for diagnosis and treatment of VTE to find systematic reviews and meta-analyses, randomized trials, and prospective cohort studies published between January 1, 2013, and July 31, 2018. The 10th edition of the American College of Chest Physicians Antithrombotic Therapy Guidelines was screened to identify additional studies. Screening of titles, abstracts, and, subsequently, full-text articles was performed in duplicate, as well as data extraction and risk-of-bias assessment of the included articles. Findings Thirty-two articles were included in this review. The application of an age-adjusted D-dimer threshold in patients with suspected PE has increased the number of patients in whom imaging can be withheld. The Pulmonary Embolism Rule-Out Criteria safely exclude PE when the pretest probability is low. The introduction of direct oral anticoagulants has allowed for a simplified treatment of VTE with a lower risk of bleeding regardless of etiology or extent of the VTE (except for massive PE) and has made extended secondary prevention more acceptable. Thrombolysis is best reserved for patients with massive PE or those with DVT and threatened limb loss. Insertion of inferior vena cava filters should be avoided unless anticoagulation is absolutely contraindicated in patients with recent acute VTE. Graduated compression stockings are no longer recommended to treat DVT but may be used when acute or chronic symptoms are present. Anticoagulation may no longer be indicated for patients with isolated distal DVT at low risk of recurrence. Conclusions and Relevance Over the past 5 years, substantial progress has been made in VTE management, allowing for diagnostic and therapeutic strategies tailored to individual patient characteristics, preferences, and values.

Item Type:

Journal Article (Review Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine

UniBE Contributor:

Tritschler, Tobias

ISSN:

1538-3598

Publisher:

American Medical Association

Language:

English

Submitter:

Christine Baumgartner

Date Deposited:

18 Jan 2019 09:58

Last Modified:

18 Jan 2019 09:58

Publisher DOI:

10.1001/jama.2018.14346

PubMed ID:

30326130

BORIS DOI:

10.7892/boris.123196

URI:

https://boris.unibe.ch/id/eprint/123196

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