Diagnosing Thrombosis

Diagnosing thrombosis: recognising the risk and the disease

Venous thromboembolism (VTE) is the third most common cardiovascular disorder, after ischaemic heart disease and stroke. The mortality risk associated with VTE is substantial; about 12% of VTE events occurring in hospitalised patients are fatal.^{3, 40}

Waiting for the signs and symptoms of VTE to appear before instituting anticoagulant treatment increases the risk of serious thromboembolic events.³ These events may be acutely life-threatening, such as a pulmonary embolism (PE), or may lead to long-term sequelae, including post-thrombotic syndrome and pulmonary hypertension.

The most effective and economical approach to decreasing the burden of VTE is to prevent the development of deep vein thrombosis (DVT) in patients at high risk, such as those undergoing major orthopaedic surgery on the lower extremities.³ However, when patients do develop VTE or other thrombosis-related conditions, prompt diagnosis and treatment are essential to reduce morbidity and mortality.⁴¹

Atrial fibrillation

As in VTE, optimal medical care involves identifying the patient at risk of thrombosis and instituting appropriate preventive therapy. Imaging studies help guide treatment when cardioversion is a treatment option.²²

Acute coronary syndrome

Patient history and physical exam findings, electrocardiographic data, measurement of cardiac biomarkers, and, in some cases, imaging studies are the cornerstones of diagnosis for acute coronary syndrome (ACS.)²³

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Article references

3 - 1. Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008;133(6)(suppl):381S-453S.
40 - Anderson FA Jr, Wheeler HB, Goldberg RJ, et al. A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism. The Worcester DVT Study. Arch Intern Med. 1991;151(5):933-938.
41 - Buller HR, Sohne M, Middeldorp S. Treatment of venous thromboembolism. J Thromb Haemost. 2005;3(8):1554-1560.
22 - Fuster V, Rydén LE, Cannom DS, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation. 2006;114(7):e257-e354.
23 - Bassand JP, Hamm CW, Ardissino D, et al; Task Force for Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of European Society of Cardiology. Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes. Eur Heart J. 2007;28(13):1598-1660.

Venous thromboembolism: A condition in which a blood clot (thrombus) forms in a vein, which in some cases then breaks free and enters the circulation as an embolus, finally lodging in and completely obstructing a blood vessel, e.g., in lungs causing a PE. The term encompasses both DVT and PE.
Hypertension: Persistently high arterial blood pressure. Hypertension may have no known cause (essential or idiopathic hypertension) or be associated with other primary diseases (secondary hypertension). This condition is considered a risk factor for the development of heart disease, peripheral vascular disease, stroke, and kidney disease.
Post-thrombotic syndrome: A syndrome that can follow a vascular thrombosis. Clinical signs and symptoms of this syndrome include chronic pain, swelling, oedema, discolouration, and in severe cases, venous ulceration. It is likely that valvular incompetence is associated with the clinical manifestations of post-thrombotic syndrome.
Acute coronary syndrome: This is an umbrella term used to cover any group of clinical symptoms compatible with acute myocardial ischaemia (chest pain due to insufficient blood supply to the heart muscle that results from coronary artery disease). Acute coronary syndrome covers the spectrum of clinical conditions ranging from unstable angina to STEMI and NSTEMI.

Diagnosing Thrombosis