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Evaluating patients with established venous thromboembolism for acquired and inherited risk factors

Authors
Kenneth A Bauer, MD
Gregory YH Lip, MD, FRCPE, FESC, FACC
Section Editors
Lawrence LK Leung, MD
Jess Mandel, MD
Deputy Editor
Geraldine Finlay, MD

INTRODUCTION

The most common presentations of venous thromboembolism (VTE) are deep vein thrombosis (DVT) of the lower extremity and pulmonary embolism (PE). Risk factors for VTE, either acquired or hereditary, can be identified in the majority of patients who present with VTE [1-3].  

The evaluation of the adult patient with established VTE for acquired and inherited risk factors is discussed here. Screening for thrombophilia in asymptomatic patients and management of thrombophilic disorders are discussed separately. (See "Screening for inherited thrombophilia in asymptomatic individuals" and "Inherited thrombophilias in pregnancy" and "Screening for inherited thrombophilia in children".)

INITIAL APPROACH

All patients with established venous thromboembolism (VTE) should undergo a thorough history and physical examination combined with review of diagnostic imaging studies and routine laboratory testing [1-3]. This may reveal an acquired condition (eg, major surgery) predisposing to the thrombotic event (table 1) or provide clues to the presence of inherited thrombophilia (eg, first-degree relatives with VTE at a young age). As venous thrombosis is a multifactorial disorder, some patients will have more than one major risk factor. (See "Overview of the causes of venous thrombosis" and 'Evaluation for occult malignancy' below.)

History and examination — A careful history should evaluate for the following:

Common risk factors include major surgical procedures or trauma, recent hospitalization (within the previous 90 days), pregnancy, and immobility. The presence or absence of a provoking event should be identified since duration of anticoagulation and the utility of further testing is different in patients with unprovoked compared with provoked VTE. (See "Venous thromboembolism: Anticoagulation after initial management", section on 'Duration of treatment' and 'First episode of uncomplicated unprovoked VTE' below.)  

                              

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Literature review current through: Nov 2016. | This topic last updated: Tue Sep 20 00:00:00 GMT+00:00 2016.
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