Diagnosis and treatment of venous thromboembolism.

Department of Medicine, McMaster University, Hamilton Health Sciences, Henderson Site, 711 Concession Street, Hamilton, Ontario, L8V 1C3, Canada.
Annual Review of Medicine (Impact Factor: 15.48). 02/2002; 53:15-33. DOI: 10.1146/
Source: PubMed

ABSTRACT The diagnosis of deep vein thrombosis (DVT) and pulmonary embolism (PE) has been improved and simplified over the past decade thanks to advances in noninvasive and readily accessible technology. With high degrees of sensitivity and specificity, venous ultrasonography is favored as the initial investigation for DVT. To diagnose PE, most clinicians rely on diagnostic algorithms that combine clinical assessment, noninvasive lung studies, and, if necessary, venous ultrasonography of the legs and D-dimer testing. Substantial progress has also occurred in the treatment of acute venous thromboembolism with the introduction of low-molecular-weight heparins. This class of antithrombotic agents has changed initial therapy from an inpatient, intravenous regimen that required laborious monitoring to an outpatient practice using weight-adjusted doses of once-daily subcutaneous injections. In addition, several new anticoagulants with theoretical advantages over existing agents have entered phase III studies. Aspects of thrombosis treatment that remain controversial include vena caval interruption and the indications for thrombolysis and surgical thromboembolectomy.

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    ABSTRACT: Pulmonary embolism is one of the greatest diagnostic challenges in emergency medicine and clinical probability assessment is a fundamental step in its diagnosis.AimTo evaluate the role of estimating clinical probability of pulmonary embolism and to compare between different pre-test probability scoring systems as regards their sensitivity and specificity.Patients and methodsWe used seven scoring systems (original Geneva score, revised Geneva score, simplified Geneva score, Wells score, simplified Wells score, simplified Charlotte rule, Pisa model) to assess the clinical probability of PE in 41 patients with suspected pulmonary embolism for whom the final diagnosis was based on multislice CT pulmonary angiography (CTPA).ResultsTwenty-four patients (58.5%) had pulmonary embolism. The scores with the strongest correlation with the result of CTPA were the Pisa model (P ⩽ 0.001) followed by the original Geneva score and the Wells score (P ⩽ 0.01). Simplified Wells score had the highest sensitivity (0.92), Pisa model had the highest specificity (0.82) and the highest overall accuracy (0.76).Conclusion For most patients, clinical probability assessment is an easy and effective way to decide which patient should undergo further investigations. Among the studied seven scores, the Pisa model has the best correlation with the CTPA results and it has a good sensitivity, specificity, positive and negative predictive values and the highest overall accuracy.
    10/2012; 61(4):419–424. DOI:10.1016/j.ejcdt.2012.07.002
  • Drugs 01/2004; 64(6). DOI:10.2165/00003495-200464060-00010 · 4.13 Impact Factor
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    ABSTRACT: Computed tomographic pulmonary angiography (CTPA) is a gold standard test for the diagnosis of pulmonary embolism (PE), but is reported to be over prescribed. We performed this study to determine over prescription of CTPAs at a District General Hospital (DGH) in the United Kingdom. Our secondary aim was to establish a cause of its over-prescription.
    Journal of Ayub Medical College, Abbottabad: JAMC 01/2014; 26(1):76-9.


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Jun 3, 2014