Chapter 22: Management and Prevention of Venous Thromboembolism

The following sections are included:

• Deep vein thrombosis (DVT) and pulmonary embolism (PE) are the leading causes of preventable in-patient mortality following surgery.

• Many DVTs are asymptomatic, but are still a risk for PE.

• Validated clinical prediction rules should be used to estimate the pretest probability of venous thromboembolism (VTE), e.g., Wells score.

• D-dimer level measurements are useful screening tests.

• Ultrasonography is the current first-line imaging investigation for DVT.

• Newer anticoagulants such as rivaroxaban and dabigatran are now being used for prophylaxis and treatment of VTE.

• Inferior vena caval filters (IVCFs) should be used when anticoagulation is contraindicated or further VTE occurs despite adequate anticoagulation.

• DVT can lead to post-thrombotic syndrome (PTS) in the longer term.

• Thrombolysis should be considered in younger, fitter patients with ileofemoral DVT to reduce PTS risk.