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Dec 1, 2019 Issue
Diagnosing VTE: Guidelines from the American Society of Hematology [Practice Guidelines]
The American Society of Hematology has published recommendations for determining the optimal diagnostic strategy based on pretest risk.
Vitamin K antagonists, unfractionated heparin, low-molecular-weight heparin, and direct oral anticoagulants are commonly used for the prevention and treatment of systemic embolism associated with atrial fibrillation, stroke, and venous thromboembolism. Low-molecular-weight heparin and select direct oral anticoagulants can be used for anticoagulation therapy initiation on an outpatient basis. Indications for anticoagulation therapy and other related recommendations from guidelines are discussed in this article.
Use of the PERC clinical decision rule significantly reduces the need for CT pulmonary angiography in adults with an initial low-risk clinical estimate of suspected PE.
Standard management of acute PE includes five days of inpatient treatment with parenteral anticoagulation, followed by long-term oral anticoagulation as an outpatient. However, guidelines from the American College of Chest Physicians state that early discharge before five days can be considered in s...
Jun 1, 2018 Issue
Ruling Out Pulmonary Embolism in the Primary Care Setting [Point-of-Care Guides]
What is the best approach to evaluate patients with suspected pulmonary embolism in the outpatient, primary care setting?
In this study, using a simplified algorithm in patients with suspected pulmonary embolism can safely decrease the number of CTAs.
Oct 15, 2017 Issue
Rivaroxaban vs. Warfarin for Treatment of DVT and PE [FPIN's Clinical Inquiries]
Rivaroxaban, along with the other factor Xa inhibitors, is as effective as or better in the short term (three months) than warfarin (Coumadin) for preventing recurrent DVT, nonfatal PE, and fatal PE, with no differences in mortality or bleeding events.
Anticoagulation is the mainstay of therapy for venous thromboembolism. Most patients can be treated in the outpatient setting with low-molecular-weight heparin and a vitamin K antagonist (warfarin) or direct-acting oral anticoagulants.
There is no advantage to adding CT of the abdomen and pelvis to a basic screening protocol for occult malignancy in patients with unprovoked VTE.
Continuing warfarin therapy for 18 months after an unprovoked PE reduces the risk of recurrent symptomatic venous thromboembolism (VTE). However, benefit beyond 18 months is not maintained after the warfarin is discontinued.