Venous Thromboembolism Evaluation & Management in the Emergency Department

Why Clinicians Ought to Consider a Screening Tool for Venous Thromboembolic Disease (VTE)?

Screening for VTE is crucial for early diagnosis, reducing complications, preventing recurrence, and improving overall patient outcomes.

1. Early Detection and Prevention of Severe Complications
   • VTE, which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), can be life-threatening if not detected early.
   • Early diagnosis allows for timely interventions to prevent severe outcomes such as PE, which can be fatal.
2. Cost-Effective Prevention Strategy
   • Detecting VTE early reduces the economic burden associated with advanced disease treatment, including hospitalizations and long-term anticoagulation therapy.

App Components

The VTE Screening app incorporates several assessment modalities to assist the clinician in detecting the presence and pre-test probability of VTE and determining if the patient is a candidate for inpatient vs. outpatient care.

1. Wells Score Calculator for DVT and PE
2. PERC Rule and Hestia Criteria for Pulmonary Embolism
3. Clinical Decision Tree for Suspected VTE when Radiological Confirmation is not immediately available
4. Antithrombotic Medication Management Strategies for Inpatient and Outpatient Management
5. Select Non-pharmacological VTE management

Studies indicate that appropriate anticoagulation therapy can decrease the rates of recurrent VTE and associated complications. Additional factors, such as bleeding risk, also play a role in the judicial use of anticoagulants. Medication treatment plans in the presence of bleeding risk factors will require additional scrutiny as the clinician and patient weigh the risks versus benefits.

The content of this app provided is for informational purposes for medical professionals only and is not intended to be used or relied upon by them as specific medical advice, diagnosis, or treatment, the determination of which remains the responsibility of the medical professionals for their patients.

App Logic

To learn how the app logic works, you can inspect the app builder or refer to the VTE Evaluation & Management in the Emergency Department App Logic Map.

For use in the treatment of hemodynamically stable patients with VTE who do not exhibit symptoms of limb ischemia.  

Transfer immediately to a Vascular Specialist if the patient:

• is hemodynamically unstable,
• has signs or symptoms of limb ischemia,  *OR*
• has a highly symptomatic DVT and/or ischemic symptoms on ambulation.

Patients are NOT required to have radiological confirmation of VTE to be assessed under this app.

Should multiple scenarios be present (i.e., DVT and PE), the app should be run individually for each scenario, with the highest level of care assigned to the patient (e.g., transfer > inpatient > outpatient.)