Controversies in treating small clots in the leg and in the lung
EHA Library. Schellong S. 06/14/17; 185045
Topic: 6Ca Diagnosis and treatment of venous thromboembolism
Sebastian Schellong
Contributions
Contributions
Learning Objectives
Walter Ageno - Chair Introduction
Inflammation is a protective tissue response to injuries, which involves blood vessels and leukocytes, together with several mediators. Inflammatory processes have a role in the initiation and evolution of atherosclerosis and in the progression to acute thrombotic complications. There is also growing evidence on the association between inflammation and venous thromboembolism (VTE). Inflammatory processes influence initiation and propagation of coagulation activation, downregulation of anticoagulant pathways and inhibition of fibrin removal.
The diagnostic approach to patients with clinically suspected VTE has evolved over time. Initially, diagnosis was only made on clinical grounds, but because signs and symptoms of VTE are nonspecific, objective diagnostic methods were required for a correct diagnosis. However, only a minority of patients referred for imaging tests is actually confirmed to have VTE, thus questioning the cost-effectiveness of their routine use in clinical practice. To improve the diagnostic approach to patients with suspected VTE, algorithms integrating clinical data, laboratory, and imaging tests have been developed and implemented.
The improved diagnostic yield of imaging tests has contributed to an increased detection of small clots with uncertain clinical impact. This is in particular the case of isolated distal deep vein thrombosis and subsegmental pulmonary embolism. Whether these patients require routine anticoagulant treatment remains a matter of debate.
Learning Objectives of the manuscript
After viewing this presentation the participant will be able to:
- To understand the role of coagulation in inflammation and the impact of inflammation on thromboembolic disorders.
- To select the most appropriate diagnostic approach for patients with clinically suspected deep vein thrombosis or pulmonary embolism, with the aim to safely reduce the need for imaging tests.
- To decide the correct therapeutic strategies for patients with small clots such as isolated distal deep vein thrombosis and patients with subsegmental pulmonary embolism.
Learning Objectives of the presentation
After viewing this presentation the participant will be able to:
- Acknowledge the new situation that for DVT as well as for PE the current standard diagnostic imaging detects clots in the leg and the lung which might be clinically insignificant and do not require standard treatment.
- Define a subgroup of patients with isolated distal DVT which represents a very low risk group for proximal extension and PE.
- Discuss the risk difference of two different patient groups with subsegmental PE: cancer patients with incidental PE versus symptomatic patients without cancer.
Inflammation is a protective tissue response to injuries, which involves blood vessels and leukocytes, together with several mediators. Inflammatory processes have a role in the initiation and evolution of atherosclerosis and in the progression to acute thrombotic complications. There is also growing evidence on the association between inflammation and venous thromboembolism (VTE). Inflammatory processes influence initiation and propagation of coagulation activation, downregulation of anticoagulant pathways and inhibition of fibrin removal.
The diagnostic approach to patients with clinically suspected VTE has evolved over time. Initially, diagnosis was only made on clinical grounds, but because signs and symptoms of VTE are nonspecific, objective diagnostic methods were required for a correct diagnosis. However, only a minority of patients referred for imaging tests is actually confirmed to have VTE, thus questioning the cost-effectiveness of their routine use in clinical practice. To improve the diagnostic approach to patients with suspected VTE, algorithms integrating clinical data, laboratory, and imaging tests have been developed and implemented.
The improved diagnostic yield of imaging tests has contributed to an increased detection of small clots with uncertain clinical impact. This is in particular the case of isolated distal deep vein thrombosis and subsegmental pulmonary embolism. Whether these patients require routine anticoagulant treatment remains a matter of debate.
Learning Objectives of the manuscript
After viewing this presentation the participant will be able to:
- To understand the role of coagulation in inflammation and the impact of inflammation on thromboembolic disorders.
- To select the most appropriate diagnostic approach for patients with clinically suspected deep vein thrombosis or pulmonary embolism, with the aim to safely reduce the need for imaging tests.
- To decide the correct therapeutic strategies for patients with small clots such as isolated distal deep vein thrombosis and patients with subsegmental pulmonary embolism.
Learning Objectives of the presentation
After viewing this presentation the participant will be able to:
- Acknowledge the new situation that for DVT as well as for PE the current standard diagnostic imaging detects clots in the leg and the lung which might be clinically insignificant and do not require standard treatment.
- Define a subgroup of patients with isolated distal DVT which represents a very low risk group for proximal extension and PE.
- Discuss the risk difference of two different patient groups with subsegmental PE: cancer patients with incidental PE versus symptomatic patients without cancer.
{{ help_message }}
{{filter}}