Practical Management of VTE: Simplifying Prophylaxis
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Video Transcription
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Hello, it's my pleasure to be able to speak to you today about the real-world anticoagulation
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practice in venous thromboembolism. My name is Teresa Carmen. I'm from University Hospitals Case Medical Center. I have no disclosures relevant to this topic and I'm going to avoid
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off-label discussions of the anticoagulants. Today, I want to make sure we understand and recognize the need for an individual patient-centered management plan for patients with
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venous thromboembolism. Not all VTE is created equal. I'm going to help us develop an algorithm
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for comprehensive patient evaluation and to get us started on choosing our anticoagulants, we're
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going to discuss how comorbidities may influence the choice of anticoagulants that we're going to
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use. So venous thromboembolism is a spectrum of disease. We can range from pulmonary embolism, which may be massive or clinically relevant and with high clinical risk,
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isolated internal jugular vein thrombosis, or even IBC filter thrombosis. In addition, we have
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other types of venous thromboembolism, such as distal VVT or Padgett-Schroeder syndrome and
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incidental PE. And all of these patients with venous thromboembolism are not created equal
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and they all need an individual assessment and management plan. Now, there are different levels
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of management. Usual management would consist of clinical assessment, imaging for diagnosis,
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anticoagulation. We may search for a reason why and then we discharge the patient for follow-up.
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I think, however, we need to get past that and go to a higher level of management using our
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risk prediction tools, our biomarker support for diagnosis and management. Start anticoagulation
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while we consider the diagnosis of venous thromboembolism and then do our imaging that may be appropriate. When we talk about anticoagulation for treatment, it needs to be
Video Summary
In this video, Dr. Teresa Carmen discusses the management of venous thromboembolism (VTE). She emphasizes the need for an individualized patient-centered approach, as not all VTE cases are the same. Dr. Carmen suggests using risk prediction tools and biomarkers for diagnosis and management. She also discusses the choice of anticoagulant therapy, taking into consideration comorbidities and the need for interventions. Dr. Carmen notes that anticoagulants should be started as soon as VTE is suspected, even before definitive testing is done. She discusses the diagnostic tests commonly used, such as duplex ultrasound, CTA, and VQ scan. Dr. Carmen also provides recommendations for the choice of anticoagulant therapy based on different patient scenarios and comorbidities. She highlights the importance of patient education, follow-up, and management of post-VTE events. Finally, she discusses the implications of factors like obesity, chronic kidney disease, liver disease, bariatric surgery, and cancer on the choice of anticoagulants.
Keywords
venous thromboembolism
individualized approach
anticoagulant therapy
diagnostic tests
comorbidities
patient education
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