We searched MEDLINE, Embase, and the Cochrane Library for papers published in English from Dec 1, 2009, to March 31, 2016, using combinations of the following terms: “deep vein thrombosis”, “pulmonary embolism”, “venous thromboembolism”, “epidemiology”, “diagnosis”, “prognosis”, and “treatment”. We gave preference to publications from the past 5 years, but did consider highly regarded older publications. We screened the reference lists of articles identified by the search strategy and included
SeminarDeep vein thrombosis and pulmonary embolism
Introduction
Deep vein thrombosis and pulmonary embolism are manifestations of venous thromboembolism. Although deep vein thrombosis develops most often in the legs, the deep veins of the arms, the splanchnic veins, and the cerebral veins can be affected. In this Seminar we focus on the epidemiology, diagnosis, and treatment of deep vein thrombosis of the legs and pulmonary embolism. Prevention of venous thromboembolism is outside the scope of this Seminar.
Section snippets
Epidemiology
Venous thromboembolism is a major global burden with about 10 million cases occurring every year, thereby representing the third leading vascular disease after acute myocardial infarction and stroke.1 Just under half a million deep vein thromboses and 300 000 pulmonary embolisms occur every year in six European countries with 300 million inhabitants.2 The yearly economic burden of venous thromboembolism in the USA has been estimated to be US$7–10 billion.3 Incidence is steadily increasing
Clinical presentation
Clinical manifestations of deep vein thrombosis of the legs include swelling or pitting oedema, redness, tenderness, and presence of collateral superficial veins. Signs and symptoms of pulmonary embolism comprise sudden onset of dyspnoea or deterioration of existing dyspnoea, chest pain, syncope or dizziness due to hypotension or shock, haemoptysis, tachycardia, or tachypnoea. Abnormalities on chest radiography, electrocardiography, or blood gas analysis are not specific for pulmonary embolism,
Anticoagulant therapy
Anticoagulant therapy is the mainstay for the treatment of venous thromboembolism and is classically divided into three phases: the acute phase of the first 5–10 days after venous thromboembolism diagnosis, a maintenance phase of 3–6 months, and an extended phase beyond this period.85 During the acute phase, treatment options include subcutaneous low-molecular-weight heparin or fondaparinux, intravenous unfractionated heparin, or the direct oral factor Xa inhibitors rivaroxaban and apixaban (
Future research
Venous thromboembolism is a common disease accounting for major global morbidity and mortality. A wide range of physicians are involved in its diagnostic and therapeutic management. The introduction of direct oral anticoagulants has marked the beginning of a new era in the treatment of venous thromboembolism; however, many diagnostic and therapeutic research questions are still unanswered. Does the widespread use of imaging in combination with advances in imaging techniques truly result in
Search strategy and selection criteria
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