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Feature Article

Venous thromboembolism. Applying new guidelines in primary care

THOMAS DAY, HUYEN TRAN
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© TODD BUCK
© TODD BUCK

Abstract

Venous thromboembolism (VTE) is a potentially life-threatening diagnosis commonly encountered in the primary care setting. New guidelines from the Thrombosis and Haemostasis Society of Australia and New Zealand for the diagnosis and management of VTE provide physicians with evidence-based guidance on this challenging area of medicine.

Key Points

  • The Thrombosis and Haemostasis Society of Australia and New Zealand guidelines on management of venous thromboembolism (VTE) provide succinct, evidence-based guidance on diagnosing and managing deep vein thrombosis and pulmonary embolism.
  • The diagnosis of VTE rests on radiological findings. Imaging is not required in patients with a low clinical likelihood and a negative d-dimer test result.
  • Almost all patients with VTE require anticoagulation therapy.
  • Apixaban and rivaroxaban are now the preferred anticoagulants in most patients with VTE, although low molecular weight heparin remains the agent of choice in pregnant and breastfeeding women.
  • Duration of anticoagulation is determined by risk of progression and recurrence and must be weighed against bleeding risk.
  • Inherited thrombophilia rarely influences management decisions, and routine testing is not indicated.
  • Patients should be monitored to ensure ongoing benefit of anticoagulation and to identify chronic complications of VTE.

Figures

© TODD BUCK
© TODD BUCK