Approach to: Venous Thromboembolism

Venous thromboembolisms can manifest as a spectrum of diseases and complications, such as deep vein thrombosis (DVT) and pulmonary embolism (PE), as a consequence of hypercoagulability, endothelial damage and/or venous stasis. DVT can present as localized pain or heaviness, unilateral edema, dilatation of superficial nonvaricose veins, a palpable cord or Homans’s sign. Symptoms of PE include acute or worsening shortness of breath and pleuritic chest pain while physical examination may be remarkable for tachycardia and tachypnea. However, given their non-specificity, using these signs and symptoms alone allows for poor differentiation between VTE and other entities. This review will focus on a multi-step diagnostic tree allowing for evidence-based interpretation of tests following a determined pre-test probability (PTP), as per Thrombosis Canada recommendations and ASH clinical guidelines. An introduction to VTE in Pediatrics and pregnancy will also be discussed.