Bonus Material-14_Roto - Thromboembolic disease 2025

Pdf Summary

This presentation by Dominick Roto, DO, from the University of Rochester Medical Center, covers thromboembolic diseases with a focus on deep vein thrombosis (DVT), pulmonary embolism (PE), and non-thrombotic pulmonary emboli.<br /><br />Key learning objectives include: assessing pretest probability for DVT and appropriate diagnostic tests; risk stratification and management of acute PE; and understanding differential diagnoses for non-thrombotic pulmonary embolism.<br /><br />For DVT, clinical assessment using Wells criteria guides testing. Low-risk patients get a D-dimer test unless confounding conditions exist, in which case ultrasound is indicated. Moderate to high risk warrants ultrasound imaging. Risk factors include immobility, surgery, hormone therapy, cancer, COVID-19, and inflammatory diseases. Treatment includes anticoagulation for nearly all cases, with duration typically 3 months for provoked DVT and possibly extended for unprovoked cases.<br /><br />Acute PE diagnosis also uses Wells score and further testing with PERC, D-dimer, or CT angiography based on risk. Mortality can approach 30%. Risk stratification relies on hemodynamics and right ventricular (RV) dysfunction assessed by imaging (CT, echocardiography) and biomarkers (troponin, NT-proBNP). High-risk patients require urgent systemic thrombolytics unless contraindicated; anticoagulation is essential for all. Intermediate-risk patients are treated with anticoagulation and monitored, reserving thrombolytics for deterioration. Treatment duration mirrors DVT guidelines with a minimum of three months.<br /><br />Special considerations for PE in pregnancy include diagnosis via chest X-ray and CT angiography (V/Q scans less favored) and treatment with low molecular weight heparin antenatally. Postpartum anticoagulation depends on breastfeeding status, with DOACs used if not breastfeeding. High-risk patients receive thrombolytics or catheter-based therapies as indicated.<br /><br />Non-thrombotic pulmonary emboli include septic emboli (from right-sided endocarditis), amniotic fluid embolism (postpartum coagulopathy), air embolism (usually iatrogenic), fat embolism (post-fracture), and pulmonary tumor thrombi (poor prognosis in malignancy). Management varies from antibiotics and supportive care to chemotherapy.<br /><br />The presentation incorporates case scenarios to apply diagnostic and treatment principles, emphasizing guideline-based care for thromboembolic diseases.

Meta Tag

Concept Deep Vein Thrombosis

Concept Wells Criteria

Concept Anticoagulation

Concept Pulmonary Embolism

Concept Pretest Probability

Keywords

deep vein thrombosis

pulmonary embolism

Wells criteria

D-dimer

ultrasound imaging

anticoagulation

thrombolytics

pregnancy

non-thrombotic pulmonary emboli

right ventricular dysfunction

Deep Vein Thrombosis

Wells Criteria

Anticoagulation

Pulmonary Embolism

Pretest Probability