Management of patients with venous thromboembolism after the initial treatment period

Timothy M. Fernandes, Manreet Kanwar, Richard White

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background: Venous thromboembolism (VTE) is a common medical problem seen in primary care settings. The most common long-term adverse sequelae are recurrent thromboembolism and incomplete resolution of the embolic material, which may result in pulmonary hypertension after pulmonary embolism and post-thrombotic changes in the leg after deep vein thrombosis. Although there are detailed guidelines for diagnosing and treating acute VTE, there are few focused articles that provide recommendations for primary care physicians (PCPs) about how to manage VTE patients after completion of the initial period of anticoagulation treatment. Observations: In this article, we highlight several important clinical decisions that must be addressed after the first 3 months of anticoagulation treatment is complete, with a focus on particular management issues for PCPs. Conclusions: The 2 most important decisions the PCP must make are to determine, first, if symptoms of acute VTE have indeed resolved, and second, if they have resolved, to assess the long-term risk of recurrent VTE versus the risk of potential bleeding and decide if anticoagulation should be stopped, or if indefinite anticoagulation treatment is indicated. Among higher-risk patients who may benefit from indefinite anticoagulation, the PCP should discuss both the risks and benefits of anticoagulation treatment, empowering the patient to actively participate in this important shared decision-making process.

Original languageEnglish (US)
Pages (from-to)409-419
Number of pages11
JournalJournal of the American Board of Family Medicine
Volume34
Issue number2
DOIs
StatePublished - Mar 2021
Externally publishedYes

Keywords

  • Anticoagulants
  • Deep Vein Thrombosis
  • Dyspnea
  • Evidence-Based Medicine
  • Primary Care Physicians
  • Primary Health Care
  • Pulmonary Embolism
  • Pulmonary Hypertension
  • Shared Decision-Making
  • Venous Thromboembolism

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Family Practice

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