The History of Diagnosing Venous Thromboembolism.

An accurate and prompt diagnosis of deep vein thrombosis and/or pulmonary embolism is important to prevent serious complications and mortality. Because the clinical presentation of venous thromboembolism (VTE) is often nonspecific, objective testing by means of radiological imaging is required to confirm the diagnosis. Historically, a diagnosis of VTE involved invasive imaging techniques like contrast venography or conventional pulmonary angiography. Technological developments toward more accurate and less invasive diagnostics have driven the implementation of a variety of newer technologies over the past decades, as well as the derivation and validation of clinical decision rules (CDRs) that can be used to rule out VTE in combination with D-dimer blood tests. In this narrative review, we provide a historical overview of the most notable developments in the imaging techniques and CDRs for VTE diagnosis.

Venothromboembolic signs and medical eponyms: Part II.

Eponyms were established to serve the purpose of honoring individuals who have made important observations and discoveries. The use of eponyms remains controversial, and important questions have been raised regarding their appropriateness. Although there have been instances where eponyms were abandoned, the remainder are largely embedded within the established literature making their disappearance unlikely. Physicians used a variety of techniques to describe signs of medical eponyms as a method for diagnosing deep venous thrombosis (DVT), pulmonary embolism (PE) or venothromboembolism (VTE). These methods (observation, palpation, pressure, or maneuvers), were detected during the physical examination and using bedside sphygmomanometer or radiographic imaging. Reviewed are both common and less frequently encountered VTE eponyms identified during the physical examination and radiologic imaging. Most of these signs have not been further studied and, therefore, there is a lack of information regarding their accuracy and reliability in clinical practice.

Venothromboembolic signs and medical eponyms: Part I.

Eponyms are honorific terms ascribed to individuals who discovered a sign, test, syndrome, technique, or instrument. Despite some contentions, eponyms continue to be widely ingrained and incorporated into the medical literature and contemporary language. Physical signs are considered unreliable methods alone for detecting deep venous thrombosis (DVT). The accuracy of the majority of these signs is unknown. For those signs that have been studied, there are a number of methodological limitations hindering the ability to draw meaningful conclusions about their accuracy and validity in clinical practice. Nevertheless, some findings when present and used in conjunction with other key signs, symptoms, and aspects of the patients history may be useful in further supporting the clinical suspicion and likelihood of DVT and/or pulmonary embolism (PE) or venothromboembolism (VTE). These signs also provide the means to better recognize the relationship between clinical findings and VTE. The acquisition of historical knowledge about these signs is important as it further enhances our understanding and appreciation of the diagnostic acumen that physicians were required to employ and to diagnose VTE prior to the advent of advanced imaging methods. Described in this paper is a brief overview of thrombosis as enumerated by Rudolf Virchow, and eponymous signs described in the late eighteenth and nineteenth centuries.

Anticoagulation in Pulmonary Embolism: Update in the Age of Direct Oral Anticoagulants.

The emergence of direct oral anticoagulants (DOACs) represents a major advancement and paradigm shift in the treatment of venous thromboembolism. Currently, dabigatran, rivaroxaban, apixiban, and edoxoban are approved and used routinely for the prevention and treatment of patients with venous thromboembolism. Because each of the DOACs has different doses and dosing regimens, clinicians need to become familiar with their use. This article focuses on the practical considerations of how and when to use the DOACs. It also aims to explore follow-up monitoring, use in special populations, reversal agents, periprocedural management, and how to handle bleeding complications with the DOACs.

Maternal mortality in New York--Looking back, looking forward.

New York City was ahead of its time in recognizing the issue of maternal death and the need for proper statistics. New York has also documented since the 1950s the enormous public health challenge of racial disparities in maternal mortality. This paper addresses the history of the first Safe Motherhood Initiative (SMI), a voluntary program in New York State to review reported cases of maternal deaths in hospitals. Review teams found that timely recognition and intervention in patients with serious morbidity could have prevented many of the deaths reviewed. Unfortunately the program was defunded by New York State. The paper then focuses on the revitalization of the SMI in 2013 to establish three safety bundles across the state to be used in the recognition and treatment of obstetric hemorrhage, severe hypertension in pregnancy, and the prevention of venous thromboembolism; and their introduction into 118 hospitals across the state. The paper concludes with a look to the future of the coordinated efforts needed by various organizations involved in women's healthcare in New York City and State to achieve the goal of a review of all maternal deaths in the state by a multidisciplinary team in a timely manner so that appropriate feedback to the clinical team can be given and care can be modified and improved as needed. It is the authors' opinion that we owe this type of review to the women of New York who entrust their care to us.

The evolution of anticoagulant therapy.

Arterial and venous thromboembolism are leading causes of morbidity and mortality around the world. For almost 70 years, heparins (unfractionated heparin and low molecular weight heparins) and vitamin K antagonists have been the leading therapeutic medical options for the treatment and prevention of thromboembolic disorders. Nevertheless, the many limitations of these traditional anticoagulants have fuelled the search for novel agents over the past 15 years, and a new class of oral anticoagulants that specifically target activated factor X and thrombin has been developed and is now commercially available. In this narrative review, the evolution of anticoagulant therapy is summarised, with a focus on newer oral anticoagulants.

Diagnostics in venous thromboembolism: from origin to future prospects.

Venous thromboembolism (VTE) is a prevalent and life-threatening condition that requires an accurate and timely diagnosis. The current diagnostic approach to this condition, entailing an efficient integration of clinical judgment, diagnostic imaging, and laboratory testing, is the result of decades of scientific and medical research. This article aims to present and discuss the major breakthroughs that have occurred in the diagnostic imaging of both deep vein thrombosis and pulmonary embolism, along with the various biological markers that have emerged from the laboratory bench and which have only marginally migrated to the bedside. Despite decades of research, the current diagnostic armamentarium for an efficient diagnosis of VTE remains suboptimal, and some wiggle room remains for the development of more efficient diagnostic tools, which may include thrombus-targeted molecular imaging, infrared thermal imaging, thrombin generation, and proteomics.

In search of venous thromboembolism: the first 2913 years.

OBJECTIVE: Venous thromboembolism was first described in India around 600-900 BC. It was not until the 17th through 19th centuries that Western researchers began to understand the anatomy, physiology, and pathology of deep venous thrombosis and pulmonary embolism. Roentgen's discovery of x-rays in 1895 led to the first objective imaging. CONCLUSION: Currently, scintigraphy, helical CT, MRI, and sonography provide accurate in vivo images. These high-quality images have forced clinicians to reevaluate many preimaging assumptions about and treatments for venous thromboembolism.

Regulatory, policy and quality update for venous thromboembolism and stroke in United States hospitals.

Stroke and venous thromboembolism (VTE) have a large impact on the United States (US) healthcare system. It is estimated that up to 1.7million new and recurrent stroke and VTE events are occurring in the US on an annual basis with the combined cost approaching over $200billion per year. A significant amount of stroke and VTE are preventable from appropriate antithrombotic use in at-risk patients and the Center for Medicaid and Medicare Services, the Joint Commission, the National Quality Forum and other key quality and regulatory entities have prioritized minimizing the impact of morbidity, mortality and avoidable costs related to these diseases. This review provides a brief history, overview, and update for the development of quality measures, quality systems, and regulatory and policy changes as related to stroke and VTE within the US healthcare system.

Anticoagulation strategies for venous thromboembolism.

Venous thromboembolism (VTE) continues to be a major source of morbidity and mortality in the United States with an estimated incidence of greater than 600 000 clinically evident cases each year. It results in more than 200 000 deaths per year and is thought to be the number one cause of preventable in-hospital deaths. This review presents the history, pathophysiology, diagnostic considerations, and treatment options for VTE.