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Open Access
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.

The term venous thromboembolism (VTE) encapsulates deep vein thrombosis (DVT) and pulmonary embolism (PE). These diagnoses may present in a disparate manner, from life-threatening episodes that require urgent hospitalisation and anticoagulation plus additional therapies, to asymptomatic episodes that may not require treatment at all. Presentation may be nonspecific, and a high index of suspicion is required when the diagnosis is considered. The cornerstone of management is anticoagulant medication. Nonvitamin K oral anticoagulants (NOACs) provide a safe, convenient option for patients and clinicians, and are now preferred to warfarin in most patient groups. Primary care physicians play an important role in timely diagnosis and evidence-based treatment decisions, which may reduce mortality and morbidity as well as the large economic costs associated with these challenging diagnoses.

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The Thrombosis and Haemostasis Society of Australia and New Zealand (THANZ) are a group of clinicians and scientists whose mission statement includes the development of policies that improve health care. The THANZ guidelines on the diagnosis and management of VTE provide succinct, evidence-based guidance.1 The full guidelines are available online at www.thanz.org.au/resources/thanz-guidelines.

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© TODD BUCK
© TODD BUCK
Dr Day is the Haemostasis and Thrombosis Fellow at Alfred Health, Melbourne. Associate Professor Tran is Head of the Haemostasis and Thrombosis Unit at Alfred Health and Monash University, Melbourne, Vic.