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.

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ADVICE

Use D-Dimer Early for Suspected VTE

Use D-dimer as a first-line, very sensitive test for suspected VTE when available quickly.
Confirm diagnosis with CT angiography for PE or ultrasound for DVT after positive D-dimer or high clinical suspicion.

INSIGHT

Clinical Scores Fit Outpatient Settings

The Wells and Geneva clinical scores are tailored for outpatient or emergency settings.
In hospitalized patients, clinical gestalt combined with D-dimer may be more effective than scoring systems.

ADVICE

Whole Leg Ultrasound for DVT

Most U.S. institutions perform whole leg ultrasound from ankle to thigh for DVT.
Ask for whole leg ultrasound specifically if you are concerned about clots below the knee.

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DVT / PE Triple Distilled! Our favorite VTE pearls summarized in this fast paced recap gleaned from our discussions with Dr Oren Friedman #92 Pulmonary Embolism for the Internist and hematologist, heavy metal enthusiast, Dr Michael Streiff #154 DVT and PE Master Class. Introducing our new Triple Distilled sub-series offering shorter episodes that reinforce and refresh key concepts from past shows along with any pertinent updates.

Listeners can claim 2 hours of Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date).

Credits

Written and Produced by: Matthew Watto MD, FACP
Cover Art by: Matthew Watto MD, FACP
Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP
Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com

Sponsor: VCU Health CE

The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. Note: A free VCU Health CloudCME account is required in order to seek credit.

Time Stamps

00:00 Intro, disclaimer
01:40 Making the diagnosis of VTE
09:07 Triage and risk stratify Pulmonary Embolism
14:00 Anticoagulant choice; Duration of therapy after unprovoked DVT / PE
21:00 Workup for unprovoked DVT / PE; DOACs in special populations: at extremes of weight, advanced CKD and in antiphospholipid syndrome
28:22 IVC filters
30:20 Outro

Links

Check out the full show notes from previous Curbsiders’ shows covering VTE.

Dr Oren Friedman #92 Pulmonary Embolism for the Internist
Dr Michael Streiff #154 DVT and PE Master Class

Goals

Listeners will feel confident in the diagnosis and management of VTE

Learning objectives

After listening to this episode listeners will...

Diagnose (VTE) DVT and PE using imaging, risk scores and clinical gestalt

Risk stratify patients with pulmonary embolism

Choose the appropriate initial anticoagulant for VTE

Decide duration of anticoagulation for VTE

Recall real risks and questionable benefits of IVC filters in DVT / PE

Determine need for cancer or thrombophilia workup in unprovoked DVT / PE

Disclosures

The Curbsiders report no relevant financial disclosures.

Citation

Watto MF, Williams PN, Brigham SK, Watto MF. “#238 DVT / PE Triple Distilled”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list Final publishing date October 22, 2020.