Venous thromboembolism - manifestation and diagnosis

age of 40 years and is slightly more common in males. The long-term complication of DVT is chronic venous insufficiency resulting in limb oedema, pain and venous ulceration, which pose significant morbidity for the patient. Mortality from DVT is secondary to pulmonary embolism. Pulmonary embolism is an extremely common condition and a leading cause of death in all age groups.Prompt diagnosis and treatment can dramatically reduce the mortality rate and morbidity of the disease but this is often difficult because patients may only present with non-specific symptoms. In fact, in an estimated 80 per cent of cases diagnosis is not made until autopsy. PE affects one in every 1,000 of the UK population per year and is the second most common cause of unexpected death after ischaemic heart disease. It accounts for 10 per cent of all deaths in hospital and is a major contributing factor in a further 10 per cent. It is estimated that the cost to the NHS of post-operative DVT/PE is £200m per year. Of patients presenting with acute PE, 10 per cent will die within an hour, but if prompt diagnosis and treatment is initiated the mortality rates are significantly reduced. If patients survive the initial PE they are at risk of further embolic events with an 8 per cent one-year recurrence rate. If left untreated, a third of patients who survive the initial event will die of future embolic events, regardless of the size of the initial thrombus. The frequency of PE increases with age due to an accumulation of risk factors but it is not an independent risk factor. Risk factors for developing PE are the same as for DVT and it can be caused by venous stasis, hypercoaguability and damage to the venous intima. The most important risk factor is a prior history of DVT or PE, recent surgery or pregnancy, immobilisation, or underlying malignancy.PE is common throughout pregnancy and in women taking oestrogen-based contraceptives or hormone replacement therapy.