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Decision-Making in the Management of Venous Thromboembolism

  • Martin H. Ellis
    Correspondence
    Requests for reprints should be addressed to Martin Ellis, MD, Hematology Institute, Meir Medical Center, 59 Tchernichovsky St, Kfar Saba 44281, Israel.
    Affiliations
    Hematology Institute and Blood Bank, Meir Medical Center, Kfar Saba, Israel

    Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
    Search for articles by this author
  • Orly Avnery
    Affiliations
    Hematology Institute and Blood Bank, Meir Medical Center, Kfar Saba, Israel

    Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
    Search for articles by this author
Published:October 24, 2020DOI:https://doi.org/10.1016/j.amjmed.2020.09.027

      Abstract

      Venous thromboembolism comprising deep venous thrombosis and pulmonary embolus is common. Patients with venous thromboembolism may present to a variety of health care providers, and while a significant proportion of patients begin treatment in the hospital, ambulatory management of both deep venous thrombosis and pulmonary embolus is feasible and becoming more common. Initial anticoagulant management, investigation of venous thromboembolism etiology, and decisions about extended anticoagulation require coordinated care by physicians from multiple specialties. Comprehensive management of venous thromboembolism requires coordinated care from the time of presentation in order to expedite diagnosis, initiate timely anticoagulant treatment, determine the need for extended anticoagulation based on risk of bleeding and recurrent thrombosis, and advise on thromboprophylaxis during future high-risk periods for venous thromboembolism. In this review we use case scenarios to provide an operational framework, based on current evidence-based recommendations, for informed decision-making about a number of clinical practice issues that are frequently encountered in the management of venous thromboembolism patients.

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