How to diagnose deep vein thrombosis and pulmonary embolism in 2019?

2nd GESCAT SYMPOSIUM

José Pedro Cidade 18th of October 2019

Venous thromboembolism (VTE), clinically presenting as DVT or PE, is globally the third most frequent acute cardiovascular syndrome behind myocardial infarction and stroke

01

02Incidence rates• PE - 39115 per 100 000 population;• DVT - 53162 per 100 000 population;

03Substantial hospital associated, preventable, and indirect annual expenditures for VTE (an estimated total of up to 8.5 billion euros in the European Union)

References [2-3]

DiagnosisReference [4]

Diagnosis of PE Rates of PE confirmation among patientsundergoing diagnostic workup: low as 5%

Clinical Evaluation and Assessment of

Clinical Probability (Pre-

test)

Classification of pulmonary

embolism severity and the risk of

early (in-hospital or 30 day) death

Auxiliary Diagnostic

Tests

Reference [4]

Clinical Presentation• Dyspnoea• Chest pain• Syncope• Haemoptysis

Patient evaluation• Hypoxaemia (<40%)• Hypocapnia• X-ray abnormalities• EKG patterns: inversion t waves in leads V1-

V4, a QR pattern in V1 , S1Q3T3 pattern or simply Tachycardia (40%)

Clincal Signs and Symptoms are non-specific

Assessment of Clinical Probability (Pre-test)

References [4-6]

Classification of pulmonary embolism severity and the risk of early (in-hospital or 30 day) death

Reference [4]

Classification of pulmonary embolism

severity and the risk of early (in-hospital or 30

day) death

Reference [4]

Auxiliary Diagnostic Tests

Refe

renc

e [4

]

Auxiliary Diagnostic Tests

Refe

renc

e [4

]

Diagnosis of DVT

Clinical Evaluation and Assessment of

Clinical Probability (Pre-

test)

Auxiliary Diagnostic

Tests

References [5-6]

Clinical Presentation• Calf pain• Swelling• Increased skin vein

visibility• Erythema• Cyanosis• Unexplicated fever

Clincal Signs and Symptoms are non-specific

Assessment of Clinical Probability (Pre-test)

References [5-7]

Auxiliary Diagnostic Tests

Refe

renc

e [5

]

Thank you for your attention!

2nd GESCAT SYMPOSIUM

José Pedro Cidade 18th of October 2019

Bibliography

[1]Raskob GE, Angchaisuksiri P, Blanco AN, Buller H, Gallus A, Hunt BJ, Hylek EM, Kakkar A, Konstantinides SV, McCumber M, Ozaki Y, Wendelboe A, Weitz JI. Thrombosis: a major contributor to global disease burden. Arterioscler Thromb Vasc Biol 2014;34:23632371.[2]Wendelboe AM, Raskob GE. Global burden of thrombosis: epidemiologic aspects. Circ Res 2016;118:13401347.[3] Stavros V. Konstantinides. 2019 ESC Guidelines for the diagnosis and management of acute pulmonaryembolism developed in collaboration with the European Respiratory Society (ERS). ESC 2019;135:154879[4] Huyen A. Tran, Gibbs, H., Merriman E., New Guidelines From the Thrombosis and Haemostasis Society of Australia and New Zealand for the diagnosis and management of venous thromboembolism, ACBD 2019, 10,5694[5]Mazzolai, L., Aboyans V., Ageno W., Agnelli, G., Diagnosis and management of acute deep vein thrombosis: a joint consensus document fromthe European society of cardiology working groups of aorta and peripheral circulation and pulmonary circulation and right ventricular function, EHJ 2019, 10.1093[6] Lim, W., Le Gal, G., Bates, S.M., American Society of Hematology 2018 guidelines for management of venous thromboembolism: diagnosis of venous thromboembolism, bloodadvances.2018024828.[7] Farge, D., Frere, C., Connors, J.M., Ay, C., Khorana A.A., Munoz, A., Brenner, B., 2019 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer, Lancet Oncol 2019, 10.1016/ S1470-2045(19)30336-5