Venous thromboembolism

Case scenario

Margaret, a 67-year-old patient, is diagnosed with a pulmonary embolism (PE) after experiencing shortness of breath and chest heaviness. She has a history of heart disease, diabetes, osteoarthritis and systemic lupus erythematosus. She underwent knee replacement surgery 3 weeks ago. Her Wells score was 6 (moderate risk) and a CT pulmonary angiogram revealed a proximal PE. After confirming her renal function (creatinine clearance ~ 42 mL/min) and reviewing her blood results, her doctor prescribed apixaban 10 mg twice daily for 7 days then 5 mg twice daily.

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Introduction

Venous thromboembolism (VTE) is defined as a blood clot that starts in a vein. The term captures a broad spectrum of thromboembolic conditions including deep vein thrombosis (DVT) as well as its complication, pulmonary embolism (PE).¹ Diagnosis of VTE may be difficult but is assisted through careful clinical examination, use of validated prediction tools and diagnostic imaging.¹ Anticoagulation is the mainstay of treatment for active VTEs. Direct-acting anticoagulants (DOACs), apixaban or rivaroxaban, are the preferred therapeutic approaches for most adults