Topic(s): Pulmonary DiseaseVenous ThromboembolismVascular and Pulmonary disease
Sophia Antipolis, 20 September 2017: The first comprehensive European advice on deep vein thrombosis was recentely published in the European Heart Journal (1). The recommendations were produced by the European Society of Cardiology (ESC) Working Group on Aorta and Peripheral Vascular Diseases and Working Group on Pulmonary Circulation and Right Ventricular Function.

Deep vein thrombosis (DVT) is the formation of a blood clot (thrombus) within a deep vein, most often in the legs. It is most frequently caused by immobilisation, following major surgery or childbirth, and less commonly by flights over six hours, oral contraceptives, and genetic disorders in blood coagulation. DVT with no apparent cause could be a warning sign of cancer particularly in patients over 50 years of age.


DVT is the most frequent type of venous thromboembolism (VTE). Patients usually present with a swelling of the leg which may be inflamed and painful. If the clot in the leg breaks loose and travels to the lungs it is called pulmonary embolism (PE), which is another mode of presentation of VTE. Patients without DVT symptoms may first present with shortness of breath and PE, and DVT may be diagnosed afterwards.

“VTE is the third cardiovascular cause of death after myocardial infarction and stroke and so it is important from a public health point of view,” said author Professor Victor Aboyans. “The diagnosis and management of acute PE was addressed by ESC guidelines in 2014(2). The consensus document published today complements the PE guidelines, providing a global picture on the complete management of VTE.”

The authors provide advice on diagnosis; initial (first 5–21 days) and long-term (first 3–6 months) management; extended management (beyond first 3–6 months); and special situations such as cancer, pregnancy and DVT at unusual sites.

Regarding diagnosis, the authors highlight the importance of clinical assessment and imaging with venous ultrasound. “The signs and the symptoms of DVT differ from one patient to another and are unspecific but are still very important and recommended for the initial evaluation of patients with suspected DVT,” said lead author Professor Lucia Mazzolai. “Ultrasound is recommended as the first line diagnostic tool when lower or upper limb DVT is suspected. We also propose venous ultrasound in patients with confirmed PE as initial reference in case of DVT recurrence or further patient stratification in selected individuals.”

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