279 Deep-Venous Thrombosis and Pulmonary Thromboembolism

Venous Thromboembolism VTE encompasses deep-venous thrombosis DVT and pulmonary embolism PE. VTE causes cardiovascular death and chronic disability. PE is responsible for an estimated 100,000 to 180,000 deaths annually in the United States. Mortality rates among young and middle-aged US adults have been increasing since 2007. VTE development is linked to Virchow’s triad: stasis, hypercoagulability, and endothelial injury. Inflammation is a central trigger, tied to risk factors like cancer, obesity, and systemic hypertension. DVT commonly presents as a persistent cramp in the lower calf. PE is the Great Masquerader and most often causes unexplained breathlessness. Diagnosis uses the Wells Point Score to estimate clinical likelihood. D-dimer testing, which has high sensitivity, is useful to rule out PE. Imaging includes venous ultrasonography for DVT, looking for loss of vein compressibility, and CT of the chest with contrast for PE. PE is categorized into massive high-risk, submassive intermediate-risk, and low-risk types. Effective anticoagulation is the treatment foundation, utilizing warfarin or fixed-dose novel oral anticoagulants. Massive PE with hypotension requires immediate vasopressors like norepinephrine. Long-term consequences include post-PE syndrome and postthrombotic syndrome, which can cause skin ulceration. Prevention, typically through low-dose unfractionated or low-molecular-weight heparin, is of paramount importance.