title: Controversies in venous thromboembolism--2015.
abstract: Venous thromboembolism is commonly encountered both in the community and the in-patient setting. Despite major advances in diagnosis and treatment, there remain challenges in several clinical areas as a result of insufficient evidence to guide practice. This review covers six controversial topics, summarizes the best available evidence, and presents recommendations for practice. The clinical relevance of calf vein thrombosis and sub-segmental pulmonary embolism are often questioned; this has implications for both their diagnosis and management. The role of thrombolysis for the treatment of deep vein thrombosis (DVT) is discussed in consideration of the potential benefits and risks. Residual vein obstruction has been proposed as a predictor of recurrent thrombosis; we consider its relevance when determining the duration of anticoagulant treatment. The post-thrombotic syndrome (PTS) can be a disabling and costly consequence of DVT with limited options for prevention and treatment. We review the available evidence related to compression stockings for PTS prevention. Finally, the relationship between cancer and VTE is well recognized and this review considers the value of screening for occult cancer in patients with unprovoked VTE.
authors.affiliation: Oxford Haemophilia and Thrombosis Centre, Oxford University Hospitals, Churchill Hospital, Old Road, Headington, Oxford OX3 7LJ, United Kingdom. Electronic address: david.keeling@ndm.ox.ac.uk.
authors.forename: David
authors.initials: D
authors.lastname: Keeling
authors.affiliation: Department of Thrombosis and Hemostasis, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands. Electronic address: F.A.Klok@LUMC.nl.
authors.forename: Frederikus A
authors.initials: FA
authors.lastname: Klok
authors.affiliation: Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada. Electronic address: glegal@ohri.ca.
authors.forename: Grégoire
authors.initials: G
authors.lastname: Le Gal
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D055088:Early Detection of Cancer / Q000706:statistics & numerical data; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D061185:Mechanical Thrombolysis / Q000379:methods; D009369:Neoplasms / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000517:prevention & control*; D054070:Postthrombotic Syndrome / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D011655:Pulmonary Embolism / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D012307:Risk Factors; D053828:Stockings, Compression; D054556:Venous Thromboembolism / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D020246:Venous Thrombosis / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000628:therapy
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents
keywords: Cancer screening; Compression stockings; Deep vein thrombosis; Diagnosis; Post-thrombotic syndrome; Pulmonary embolism; Residual vein obstruction; Subsegmental pulmonary embolism; Thrombolysis; Venous thromboembolism