Question 1

What is venous thromboembolism?

Accepted Answer

Venous thromboembolism (VTE) is a spectrum of conditions involving abnormal clot formation in the venous circulation — encompassing deep vein thrombosis (DVT, clot in a deep vein — usually the leg) and pulmonary embolism (PE, clot in the pulmonary arteries). VTE causes approximately 10 million events per year globally and is the most preventable cause of in-hospital death. It ranges from incidental, asymptomatic DVT to massive, rapidly fatal PE.

Question 2

Who is at risk?

Accepted Answer

VTE risk factors are classified as acquired and inherited. Major acquired: active cancer (7-fold increased risk); prior VTE; major surgery (particularly hip/knee arthroplasty, abdominal cancer surgery); hospitalisation and immobility; major trauma; pregnancy and postpartum (5-fold risk); oral oestrogen use (combined OCP); obesity; and long-haul travel. Inherited (thrombophilias): factor V Leiden (most common in Europeans); prothrombin G20210A mutation; protein C/S or antithrombin deficiency; antiphospholipid syndrome (acquired thrombophilia). VTE risk is multiplicative when multiple factors coexist.

Question 3

What are the symptoms of DVT and PE?

Accepted Answer

DVT: unilateral leg pain, swelling (often 2+ cm difference between legs), redness, warmth and tenderness — though approximately 50% are asymptomatic. PE: sudden dyspnoea (most common), pleuritic chest pain, haemoptysis, tachycardia, hypoxia. Massive PE: cardiovascular collapse, syncope, obstructive shock. Many PEs present atypically — syncope, isolated tachycardia, unexplained breathlessness. Clinical probability scores (Wells, Geneva) guide diagnostic algorithm (D-dimer, CT pulmonary angiography).

Question 4

How is VTE treated?

Accepted Answer

Anticoagulation is the cornerstone of VTE treatment — preventing clot extension and allowing natural fibrinolysis. DOACs (apixaban or rivaroxaban — approved for initial and extended VTE treatment without LMWH lead-in) are first-line for most patients. Duration: provoked VTE (surgery, trauma) — 3 months; unprovoked VTE — 3 months minimum (extended if low bleeding risk, as recurrence risk is high); cancer-associated VTE — indefinite (while cancer active). Massive PE: systemic thrombolysis (tPA) or catheter-directed thrombolysis for haemodynamic compromise.

Question 5

How is VTE prevented in hospital?

Accepted Answer

VTE prophylaxis in hospitalised medical and surgical patients dramatically reduces PE — yet is systematically underprovided. Guidelines recommend: pharmacological prophylaxis (LMWH or UFH) for most surgical and at-risk medical inpatients (without contraindications); and mechanical prophylaxis (graduated compression stockings, intermittent pneumatic compression devices) when pharmacological prophylaxis is contraindicated. A systematic VTE risk assessment on admission (Wells, PADUA, IMPROVE scores) guides prophylaxis decisions. WHO has prioritised VTE prophylaxis as a patient safety intervention.

Question 6

What are DOACs and why have they changed VTE treatment?

Accepted Answer

Direct oral anticoagulants (DOACs) — apixaban, rivaroxaban (factor Xa inhibitors); dabigatran (thrombin inhibitor); edoxaban — have transformed VTE treatment by offering: fixed dosing without routine monitoring (vs warfarin's INR monitoring); equivalent or superior efficacy; lower intracranial haemorrhage risk; and rapid onset/offset. Rivaroxaban and apixaban can be started without LMWH lead-in. Specific reversal agents (andexanet alfa for Xa inhibitors; idarucizumab for dabigatran) manage major bleeding.

Question 7

What is cancer-associated thrombosis?

Accepted Answer

Cancer is the strongest acquired VTE risk factor — increasing risk 7-fold (and further with chemotherapy, central venous catheters and hospitalisation). VTE is the second leading cause of death in cancer patients, after the cancer itself. Approximately 20% of all VTE events occur in cancer patients. Treatment: DOAC (rivaroxaban or apixaban preferred by recent ESC/ASCO guidelines, showing non-inferiority to LMWH and improved patient convenience) or LMWH (preferred when DOACs interact with cancer therapy or in GI/GU cancer with higher bleeding risk from DOACs). Extended anticoagulation while cancer is active.

Question 8

Does VTE have long-term consequences?

Accepted Answer

VTE has several long-term consequences: post-thrombotic syndrome (PTS) — chronic venous insufficiency after DVT in approximately 25-50%, causing leg pain, swelling, skin changes and ulcers; chronic thromboembolic pulmonary hypertension (CTEPH) — in approximately 3% of PE survivors, pulmonary artery obstruction causes progressive pulmonary hypertension (treated with endarterectomy or riociguat); and high VTE recurrence rate (approximately 30% at 10 years after unprovoked VTE — driving extended anticoagulation decisions).

Question 9

How does GMJ News cover VTE?

Accepted Answer

GMJ News covers ESC VTE guidelines, DOAC evidence and access, hospital VTE prophylaxis quality, cancer-associated thrombosis, and flight-related VTE. VTE is a significant preventable cause of mortality in Georgian hospitals — directly relevant to PHIG's patient safety accreditation standards, which include VTE prevention protocols.

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