1. Thromboembolic Disease
Steven Podnos MD

2. Pulmonary Emboli
• Prevalence unclear
• Risk of Death or severe Cardiopulmonary
compromise
• Thought almost always related to DVT of
lower extremities (can be UE)

3. DVT
• Virchows Triad:
• Immobility
• Hypercoagulability
• Venous Damage

4. Who is at Risk?
• Bedridden (Immobility)
• Trauma (surgical or otherwise) , especially to
lower extremity
• Cancer (hypercoagulable)
• Central lines

5. Prevention
• Ambulation
• TED Hose?
• SCD hose
• Anticoagulation
• Filter?

6. Anticoagulation
• Unfractionated Heparin
• Low Molecular Weight Heparin
• Fondaparinux
• Dabigatran and other Thrombin inhibitors

7. Diagnosis
• DVT-ultrasound, venography
• PE-V/Q scan, CTA, Angiogram
• Role of D Dimer, screen

8. Strategy for suspected TE disease
• D Dimer screen
• If positive, ultrasound lower extremities
• If negative, CTA if possible

9. Treatment of TE disease
• Anticoagulation
• Filter-when anticoagulation not possible or
fails