The most common presentations of venous thromboembolism (VTE) are deep vein thrombosis (DVT) of the lower extremity and pulmonary embolism. A risk factor for VTE, either hereditary or acquired, can now be identified in approximately 80 percent of patients. Furthermore, there is often more than one factor at play in a given patient. As an example, 50 percent of thrombotic events in patients with inherited thrombophilia are associated with an acquired risk factor (eg, surgery, pregnancy, oral contraceptives). In addition, some patients have more than one form of inherited thrombophilia and appear to be at greater risk for thrombosis.

The approach to the adult patient with deep venous thrombosis will be discussed here with an emphasis upon the use of diagnostic tests to establish an accurate diagnosis and the initiation of anticoagulant therapy. Indications for testing for an inherited cause of thrombophilia are addressed along with the potential implications of the discovery of an underlying thrombophilic defect for the patient and affected relatives.

NUMBER OF CREDIT HOURS: The Harvard Medical School designates this educational activity for a maximum of 1 AMA PRA Category 1 credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

COST: $20.00
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OVERALL LEARNING OBJECTIVES:

1. To improve acumen in diagnosing deep venous thrombosis
2. To update knowledge on parenteral and oral anticoagulant therapy
3. To impart new information related to genetic prothrombotic risk factors

CLINICAL LEARNING OBJECTIVES:

1. To review the epidemiology of venous thrombosis
2. To appropriately diagnose acute deep venous thrombosis and initiate appropriate anticoagulant therapy
3. To identify patients with thrombosis who should undergo testing for inherited hypercoagulability and quantify the risk of thrombosis in patients with hereditary prethrombotic states
4. To discuss criteria for life-long anticoagulation

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KENNETH BAUER, MD Course Co-Director

Dr. Bauer is Professor of Medicine, Harvard Medical School. His hospital positions include Chief, Hematology Section, VA Boston Healthcare System, and Director, Thrombosis Clinical Research, Beth Israel Deaconess Medical Center in Boston. Dr Bauer received his medical degree from Stanford University School of Medicine in Stanford, California. He completed his residency in medicine at the University of Chicago Hospitals and Clinics in Illinois. He was a Fellow in Medical Oncology and a Clinical/Research Fellow in the Division of Thrombosis and Hemostasis at Dana Farber Cancer Institute and was also a Clinical/Research Fellow in the Hematology-Oncology Division at Beth Israel Deaconess Medical Center. Dr Bauer’s research interests include elucidation of the mechanisms leading to the development of a prethrombotic state and clinical evaluation of new antithrombotic drugs. Dr Bauer previously served as Chairman of Council of the International Society on Thrombosis and Haemostasis (ISTH) and is Vice-President and Scientific Program Chair (Clinical) for the XXIInd ISTH Congress to be held in Boston in July 2009. Dr Bauer has published over 200 original reports, reviews, and book chapters. DISCLOSURE:

DAVID FEINBLOOM, MD Course Co-Director

Dr. Feinbloom is an Assistant Professor of Medicine at Harvard Medical School and an Academic Hospitalist at Beth Israel Deaconess Medical Center. Dr. Feinbloom received his medical degree from the University of Massachusetts Medical School in Worcester, Massachusetts, and completed his residency in medicine at the Beth Israel Deaconess Medical Center in Boston. Dr. Feinbloom’s research interests include the development of clinical pathways for the diagnosis, prevention, and treatment of VTE, and the use of new antithrombotic drugs. DISCLOSURE: Bayer Pharmaceuticals: Primary research investigator at BIDMC for the EINSTEIN study – An oral direct factor Xa inhibitor rivaroxaban in patients with acute symptomatic deep-vein thrombosis or pulmonary embolism. This drug is in trials for the treatment of acute deep venous thrombosis and/or pulmonary embolism

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SAMUEL Z. GOLDHABER, MD Reviewer

Samuel Z. Goldhaber, MD, Professor of Medicine at Harvard Medical School, chairs the Venous Disease Coalition. Dr. Goldhaber is a Senior Staff Member of the Cardiovascular Medicine Division of Brigham and Women’s Hospital (BWH). He is Director of the BWH Venous Thromboembolism Research Group and serves as Principal Investigator of a broad range of randomized clinical trials and observational studies related to the prevention, treatment, and epidemiology of venous thromboembolism. Dr. Goldhaber is also Director of the BWH Anticoagulation Service, which cares for more than 2,000 patients. The March 10, 2005, New England Journal of Medicine published his large clinical trial that described a new method using electronic alerts to enhance venous thromboembolism prophylaxis. This intervention reduced symptomatic DVT and PE by 41%, without an increase in bleeding complications. Dr. Goldhaber is also the Principal Investigator of an ongoing multicenter trial on Physician Alerts for patients at high risk of DVT or PE who are not receiving prophylaxis. In May 2006, he co-chaired the 2-day Surgeon General’s Workshop on DVT, which was cosponsored by the National Heart Lung and Blood Institute (NHLBI). He also serves on the National Comprehensive Cancer Network and National Quality Forum to formulate new treatment and prevention guidelines for venous thromboembolism. He is President and one of four Founding Directors of the nonprofit North American Thrombosis Forum (www.NATFonline.org), one of the 19 organizations comprising the Venous Disease Coalition. DISCLOSURE: Company: Sanofi-Aventis; Eisai; Boehringer-Ingelheim; BMS; GSK Type of Relationship: Research Support, Consultant; Research Support, Consultant; Research Support, Consultant; Research Support, Consultant; Research Support

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NUMBER OF CREDITS: 1 

Harvard Medical School is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The Harvard Medical School designates this educational activity for a maximum of 1 AMA PRA Category 1 credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Upon completion of the course you will get a certificate via e-mail within 2 weeks.

Click the image to view a sample of the certificate

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