Venous Thromboembolism (VTE) refers to the formation of blood clots in the veins. It includes two major conditions: Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE). DVT occurs when a clot forms in deep veins, usually in the legs. If part of this clot breaks away and travels to the lungs, it becomes a pulmonary embolus, which is a life-threatening emergency. Early recognition and treatment are essential to prevent complications.
1. Types of Venous Thromboembolism
1. Deep Vein Thrombosis (DVT)
- Clot formation in deep veins (legs, thigh, pelvis)
- Causes pain, swelling, warmth, and tenderness
2. Pulmonary Embolism (PE)
- Clot travels to the lungs
- Causes chest pain, breathlessness, and collapse
- Potentially fatal if untreated
2. Causes and Risk Factors
Virchow’s Triad
Three major factors contribute to VTE:
- Stasis of blood flow: Long travel, immobility, paralysis
- Hypercoagulability: Cancer, pregnancy, genetic disorders
- Endothelial injury: Surgery, trauma, inflammation
Other Risk Factors
- Obesity
- Smoking
- Use of oral contraceptives
- Heart failure
- Recent major surgery
- Advanced age
3. Symptoms of VTE
Symptoms of Deep Vein Thrombosis
- Swelling in one leg
- Pain or cramping feeling in the calf
- Warm, red, or tender skin
- Visible superficial veins
Symptoms of Pulmonary Embolism
- Sudden shortness of breath
- Sharp chest pain (worse on breathing)
- Coughing up blood
- Rapid heartbeat
- Lightheadedness or fainting
PE is a medical emergency and requires immediate treatment.
4. Diagnosis
Deep Vein Thrombosis
- Doppler ultrasound: Primary test
- D-dimer test: Helps rule out VTE
- Venography: Rarely used but highly accurate
Pulmonary Embolism
- CT Pulmonary Angiography (CTPA): Gold standard
- V/Q Scan: For patients who cannot undergo CTPA
- ECG and Chest X-ray: Supportive tests
5. Treatment of VTE
Treatment focuses on preventing clot extension, reducing symptoms, and preventing recurrence.
1. Anticoagulants (Main treatment)
Injectable Anticoagulants
- Low-Molecular-Weight Heparins (LMWH): Enoxaparin
- Unfractionated Heparin (UFH)
- Fondaparinux
Oral Anticoagulants
- Warfarin
- Direct Oral Anticoagulants (DOACs):
- Apixaban
- Rivaroxaban
- Dabigatran
- Edoxaban
2. Thrombolytics
Used in severe PE when the patient is unstable.
- Alteplase
- Streptokinase
3. Mechanical Interventions
- IVC (Inferior Vena Cava) filter for patients who cannot take anticoagulants
- Catheter-directed thrombolysis
4. Compression Therapy
- Compression stockings reduce swelling and post-thrombotic syndrome
6. Complications
- Pulmonary embolism
- Post-thrombotic syndrome
- Chronic thromboembolic pulmonary hypertension (CTEPH)
- Recurrent VTE
7. Prevention of VTE
- Avoid prolonged immobility—move legs regularly
- Stay hydrated
- Use compression stockings during long travel
- Prophylactic anticoagulants in high-risk patients
- Stop smoking
- Weight management
8. Role of the Pharmacist
- Educate patients on correct anticoagulant use
- Check for drug interactions (especially warfarin)
- Monitor INR levels in warfarin users
- Counsel on bleeding risks and warning signs
- Help improve adherence to long-term therapy
- Promote lifestyle modifications to prevent clot formation
Detailed Notes:
For PDF style full-color notes, open the complete study material below: