1. Singh, Anil C. MD, MPH, FCCP
  2. Issue Editor

Article Content

Venous thromboembolism (VTE) is an important disease state that carries a high economic burden and high morbidity and mortality. The clinical spectrum is quite dynamic and heterogeneous, ranging from asymptomatic states, with incidental findings, to that of sudden death as its presenting symptom. It is a complex vascular disease with multifactorial origins in its pathogenesis, ranging from genetic to acquired causes. Its diagnosis can sometimes be elusive, and treatment can be difficult requiring the clinician to be even more astute and thoughtful when determining the most appropriate approach. The articles put forth in the journal review the multiple facets of VTE.


Sharara, Hattab, Patel, and colleagues begin the issue with an overview of the anatomy and physiology of the pulmonary circulation, describing the importance of both fetal and adult blood supply to the lungs. They review the structural architectural distortions that take place as a result of thrombi occluding vessels in both the veins and the pulmonary artery. They discuss the anatomic and physiological changes that take place and correlate to the clinical signs and symptoms.


Patel, Fasanya, Yadam, et al describe the epidemiology and pathogenesis of VTE. Their article describes the genetic and acquired factors associated with VTE and discusses the complex interactions that it plays in formation of blood clots. They then describe the effects of mechanical occlusion, chemical mediators, and hemodynamic consequences.


Alhassan, Pelinescu, Gandhi, et al discuss the clinical presentation and risk factors associated with VTE. They review the dynamic effects of the clinical signs of VTE including skin changes, swollen lower extremities, hypoxia, and hypotension. They also review in detail the provoked and unprovoked etiologies of VTE and discuss the importance of classification in regard to the duration of anticoagulation.


Alhassan, Leap, Popuri, et al describe the importance of estimating the pretest clinical probability by utilizing validated scoring systems as an initial step in approaching the patient with VTE. They also go into detail about the diagnostic tool available and describe the advantages and disadvantages of each test.


Ma, Alhassan, Sharara, et al discuss the important topic of prophylaxis. They review indications, contraindications, and mechanical and pharmacological prophylaxis in differing patient populations. They also review the nursing implications associated with prophylaxis. They note that it is important to understand the patient's clinical status and tailor prophylaxis according to each specific patient population.


Hattab, Kung, Fasanya, et al then discuss the implications of both upper and lower extremity deep vein thromboses. In this article, they detail risk factors, diagnosis, complications, and treatment modalities for both cases. They note the special circumstances in which treatment is recommended and when treatment is not necessary.


Fasanya, Silvas, Alhassan, et al review an interesting article on treatment and pulmonary embolism response teams (PERTs). They detail all of the different pharmacological treatment options available, including the new oral anticoagulants, and the recommended applications for each of their uses. They also describe the novel programs available to provide appropriate treatment of VTE, PERT programs.


Yadam, Sharara, Naddour, et al discuss the important advances in therapeutic treatment of VTE, outside of just anticoagulation. Specifically, they detail the indications and contraindications for thrombolytic therapy, inferior vena cava filter placement, and catheter-based reperfusion treatment.


Gandhi, Hewston, Yadam, Ma, et al review and describe the importance short-term and long-term consequences of VTE. They go into detail regarding complications of interventions, chronic thromboembolic pulmonary hypertension, and postthrombotic syndrome.


Singh, Foster, Chapman, et al discuss VTE in special populations. They detail the pathophysio-logy, etiology, and treatment recommendations in cancer patients, pregnant women, and athletes. They also discuss the nursing implications within each population and the importance for vigilance in the care of these patients.


Naddour, Kalani, Hattab, et al discuss the prognosis and required monitoring recommendations for patients with VTE. They discuss the importance of understanding the risk factors for recurrence and the risk for developing complications in patients with VTE. They also detail the monitoring required when each specific treatment modality is used.


Finally, Yadam, Popuri, Hattab, et al describe the major controversies associated with VTE. They review the evidence-based medicine recommendations with respect to screening, calf vein thrombosis, overdiagnosis, treatment of subsegmental pulmonary embolism, and use of compression stockings.


-Anil C. Singh, MD, MPH, FCCP


Issue Editor