Workup of First VTE - Venous Thromboembolism
Provoked ...
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Description

Workup of First VTE - Venous Thromboembolism

Provoked by strong trigger:

 - Consider age-appropriate cancer screen

 - No role for hypercoag. testing

Unprovoked OR Provoked by weak trigger:

 - Test for inherited conditions (below)

 - Test for APLAS if extensive VTE, recurrent events, or arterial clot

Unusual site - Arterial thrombosis, Portal, hepatic, splenic, renal, mesenteric, or cerebral venous thrombosis:

 - Cerebral veins: test for inherited conditions + APLAS

 - Splanchnic veins: test for inherited conditions + APLAS + MPN + PNH

Provoked VTE 

 • A/C x 3 mo. DOAC>VKA>LMWH (LMWH favored if cancer), if persistent risk factor can extend

 • Catheter-associated → no need to remove catheter if functional and able to tolerate A/C

Unprovoked

 • at least 3 mo A/C. Consider indefinite if: low-moderate bleeding risk AND unprovoked proximal DVT or symptomatic PE, recurrent VTE, or cancer (reassess annually); unprovoked have significantly higher recurrence risk (10% <1yr off A/C, 30% <5yr)

 • No evidence that “hypercoag workup” improves outcomes, rarely changes mgmt, $$$, do NOT perform at time of event



#First #VTE #Venous #Thromboembolism #diagnosis #management #unprovoked
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MGH White Book Manual
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Account created for the MGH Internal Medicine Housestaff Manual "White Book" - https://stk10.github.io/MGH-Docs/WhiteBook-2019-2020.pdf
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