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The Curbsiders Internal Medicine Podcast
#238 DVT / PE Triple Distilled
Oct 22, 2020
Dr Oren Friedman and Dr Michael Streiff discuss VTE diagnosis, risk stratification, anticoagulation choice, treatment duration, workup for unprovoked BTE, anticoagulation in special populations, and the indications for using IVC filters.
30:25
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Quick takeaways
- Diagnosing DVT and PE involves the use of D-dimer, CT angiography, and ultrasound, with risk stratification using the modified Geneva score and Wells criteria.
- Treatment options for DVT and PE vary based on severity, with low-risk outpatients managed with DOACs and unprovoked cases potentially requiring lifelong anticoagulation; IVC filter insertion should be done judiciously and removed when no longer necessary.
Deep dives
The Podcast: Overview and Core Focus
The podcast episode is a distilled recap of expert interviews on deep vein thrombosis (DVT) and pulmonary embolism (PE). The hosts provide clinical pearls and discuss the diagnosis, treatment, duration, and special patient populations. Diagnostic approaches include the use of D-dimer and CT angiography or ultrasound. The episode emphasizes the importance of considering context and individualizing treatment based on risk factors, such as surgery and unprovoked clots. Low-risk outpatients can be managed with direct oral anticoagulants (DOACs) like apixaban, while hospitalized patients often receive unfractionated heparin or low molecular weight heparin. Treatment duration varies, with unprovoked cases potentially requiring lifelong anticoagulation. Special populations, such as those with cancer or in-stage renal disease, are also discussed. IVC filters are not commonly used, except in cases where anticoagulation is contraindicated. IVC filter insertion should be done judiciously and should be removed when no longer necessary.
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