Practical Approach to VTE Management in Hospitalized Patients
Venous thromboembolism (VTE) is a commonly feared life-threatening complication in hospitalized patients. Physicians are frequently consulted to diagnose and manage VTE in obstetrics, neurology, and surgical services. VTE should be treated irrespective of the presentation (incidental or symptomatic), etiology (provoked vs. unprovoked), and location of the venous thrombosis (extremities, abdomen, or cerebral). In patients with high clinical suspicion for VTE, physicians are encouraged to empirically start anticoagulant therapy while awaiting diagnostic testing. Thrombolytic therapy is underused by physicians, which is proven to improve the mortality in hypotensive patients with pulmonary embolism. Retrievable inferior vena cava filters have an important role in the prophylaxis and management of selective groups of VTE patients. Physicians should not hesitate to place retrievable inferior vena cava filters when clinically indicated but also should make every effort to remove them when no longer needed. This article extensively reviews various diagnostic and management options based on several clinical situations.