Current Challenges in Diagnosis of Venous Thromboembolism
1
Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
2
Department of Medicine, University Health Network, Toronto, ON M5G 2C4, Canada
3
Population Health Research Institute, Hamilton, ON L8S 4L8, Canada
4
Thrombosis and Atherosclerosis Research Institute, Hamilton, ON L8L 2X2, Canada
5
Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(11), 3509; https://doi.org/10.3390/jcm9113509
Received: 18 September 2020
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Revised: 17 October 2020
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Accepted: 27 October 2020
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Published: 29 October 2020
(This article belongs to the Special Issue Venous Thromboembolism — Diagnosis, Prevention and Treatment)
In patients with suspected venous thromboembolism, the goal is to accurately and rapidly identify those with and without thrombosis. Failure to diagnose venous thromboembolism (VTE) can lead to fatal pulmonary embolism (PE), and unnecessary anticoagulation can cause avoidable bleeding. The adoption of a structured approach to VTE diagnosis, that includes clinical prediction rules, D-dimer testing and non-invasive imaging modalities, has enabled rapid, cost-effective and accurate VTE diagnosis, but problems still persist. First, with increased reliance on imaging and widespread use of sensitive multidetector computed tomography (CT) scanners, there is a potential for overdiagnosis of VTE. Second, the optimal strategy for diagnosing recurrent leg deep venous thrombosis remains unclear as is that for venous thrombosis at unusual sites. Third, the conventional diagnostic approach is inefficient in that it is unable to exclude VTE in high-risk patients. In this review, we outline pragmatic approaches for the clinician faced with difficult VTE diagnostic cases. In addition to discussing the principles of the current diagnostic framework, we explore the diagnostic approach to recurrent VTE, isolated distal deep-vein thrombosis (DVT), pregnancy associated VTE, subsegmental PE, and VTE diagnosis in complex medical patients (including those with impaired renal function).
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MDPI and ACS Style
Liederman, Z.; Chan, N.; Bhagirath, V. Current Challenges in Diagnosis of Venous Thromboembolism. J. Clin. Med. 2020, 9, 3509. https://doi.org/10.3390/jcm9113509
AMA Style
Liederman Z, Chan N, Bhagirath V. Current Challenges in Diagnosis of Venous Thromboembolism. Journal of Clinical Medicine. 2020; 9(11):3509. https://doi.org/10.3390/jcm9113509
Chicago/Turabian StyleLiederman, Zachary, Noel Chan, and Vinai Bhagirath. 2020. "Current Challenges in Diagnosis of Venous Thromboembolism" Journal of Clinical Medicine 9, no. 11: 3509. https://doi.org/10.3390/jcm9113509
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