tromboembolisme

Tromboembolisme, commonly known as venous thromboembolism (VTE), refers to the formation of a blood clot within the venous system that can either remain in place as a deep vein thrombosis (DVT) or fragment and travel to the lungs as a pulmonary embolism (PE).

Pathophysiology is explained by Virchow's triad: hypercoagulability, venous stasis, and endothelial injury. Genetic factors (thrombophilias), and acquired risks such as cancer, surgery, immobilization, pregnancy, obesity, age, and certain medications (for example estrogen-containing therapies) increase the likelihood of VTE.

Clinical presentation varies by location. DVT typically causes leg swelling, pain, and tenderness, usually in the calf or thigh. PE presents with sudden shortness of breath, chest pain, tachycardia, and, in severe cases, syncope or hemoptysis. A high index of suspicion is necessary in at-risk patients with compatible symptoms.

Diagnosis relies on objective testing. DVT is usually assessed with compression ultrasonography. PE is diagnosed with CT pulmonary angiography or a ventilation–perfusion scan. D-dimer testing helps to rule out VTE in patients with low clinical probability, and scoring tools such as the Wells score aid initial assessment.

Treatment centers on anticoagulation. First-line options include direct oral anticoagulants (DOACs) or low-molecular-weight heparin, sometimes transitioning to other agents. Typical duration is at least 3 months for provoked VTE and longer for unprovoked cases or ongoing risk factors. In massive or unstable PE, thrombolysis or catheter-directed therapy may be warranted. IVC filters are rarely indicated.

Prevention focuses on risk reduction in hospital and at home. Long-term complications can include post-thrombotic syndrome after DVT and chronic thromboembolic pulmonary hypertension after PE. Overall prognosis improves with timely treatment, though recurrence risk remains, especially after unprovoked events.