Treatment of DVT and PE

Treatment of DVT and PE

Prompt diagnosis and treatment of deep vein thrombosis (DVT) is essential to decrease both the risk of recurrence and a potentially fatal pulmonary embolism (PE). Traditionally, initial treatment of DVT and PE begins with a parenteral anticoagulant, transitioning to longer-term Vitamin K antagonist (VKA) therapy. Another option is the direct Factor Xa inhibitor rivaroxaban, an oral anticoagulant. This single-drug approach removes the need for overlapping administration of heparin and a VKA, which can be complex owing to the requirement for coagulation monitoring and dose-adjustment of the VKA. The use of compression stockings is an important adjunct to pharmacological treatment in patients with DVT. Other venous thromboembolism (VTE) treatment approaches may include: surgery; catheter-guided thrombectomy; or thrombolytic therapy.



A Serious Health Concern

From public health scares about the risk of deep vein thrombosis (DVT) on long-distance flights to high rates of pulmonary embolism (PE) in patients recovering from major surgery, venous thromboembolism (VTE) is a well-publicized and serious health issue. VTE results when a thrombus forms in a vessel and obstructs blood flow. The pathogenic factors believed to be responsible for VTE are generally considered to involve vascular wall injury, hypercoagulable state and impaired circulation, collectively known as Virchow’s triad. Many individual risk factors can contribute to an overall increased risk of VTE.


Lungs Pulmonary Embolism

The pathway of a pulmonary embolism (PE) from the lower half of the body: inferior vena cava, to right atrium, to right ventricle, to the pulmonary artery. This might eventually obstructs blood flow to the lung. Patients with deep vein thrombosis (DVT) are at risk of PE, a life-threatening event.

The pathway of a pulmonary embolism (PE) from the lower half of the body: inferior vena cava, to right atrium, to right ventricle, to the pulmonary artery. This might eventually obstructs blood flow to the lung. Patients with deep vein thrombosis (DVT) are at risk of PE, a life-threatening event.

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Deep Vein Thrombosis

Deep vein thrombosis (DVT) is usually the formation of a thrombus in the deep veins of the leg, although DVT may also occur in the veins of the upper extremities. DVT can occur spontaneously without a known underlying cause or after provoking events, such as trauma, surgery or acute illness. Complications of DVT include pulmonary embolism (PE), post-thrombotic syndrome (PTS) and a risk of VTE recurrence. The Wells score, a commonly used clinical score, quantifies the likelihood of an individual patient having DVT. Although a high Wells score indicates a clinical probability of DVT, an objective imaging technique, such as compression ultrasonography, must be used to confirm or rule out DVT.


Acute thrombosis

Acute thrombosis

Acute thrombosis of the superficial great saphenous vein (longitudinal view)

Acute thrombosis of the superficial great saphenous vein (longitudinal view)


Pulmonary Embolism

Pulmonary embolism (PE) occurs when a part of a thrombus, usually dislodged from a deep vein thrombosis (DVT), passes into the pulmonary circulation, occluding the pulmonary arteries. PE is a potentially life-threatening condition and is the most common reason for preventable hospital death. Rapid diagnosis is crucial however the diagnosis of PE may be missed because of its non-specific clinical symptoms. Long-term complications of PE include chronic thromboembolic pulmonary hypertension (CTEPH). The Wells score is one scoring system that is commonly used to predict clinical probability of PE.


Balancing the benefits and risks of treatment

Anticoagulants are effective in treating deep vein thrombosis (DVT) and pulmonary embolism (PE) but can be associated with an increased risk of bleeding and other adverse events. The balance between benefit and risk often centers on the optimal duration of anticoagulant treatment. Because longer-term treatment can increase the risk of bleeding, it should generally be given to patients at high risk of venous thromboembolism (VTE) recurrence or for specific patient subgroups. Other adverse events that should be considered include heparin-induced thrombocytopenia (HIT) and osteoporosis.


Investigational Strategies

The direct Factor Xa inhibitors apixaban and edoxaban, as well as the direct thrombin inhibitor dabigatran, are under investigation for the treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE).