With pulmonary embolism (PE), the patient often experiences acute onset of shortness of breath; sometimes the patient even pinpoints the moment of distress. following tibial fracture). Selection bias may explain these differences, resulting in contradictory results. This information is intended for medical education, and does not create any doctor-patient relationship, and should not be used as a substitute for professional diagnosis and treatment. The main risk factors for developing a venous thromboembolism include: A deep vein thrombosis refers to the formation of a blood clot in the deep veins of a limb, most commonly affecting those of the legs or pelvis. By definition, COPD patients present with respiratory symptoms, which can enhance the suspicion of PE. "The risk of venous thromboembolism (VTE) with trauma patients can be higher," said Kirill Lobastov, MD, PhD, vascular surgeon and an Associated Professor of the Pirogov Russian National Research Medical University. Other symptoms include low-grade pyrexia, pitting oedema, tenderness or prominent superficial veins. Direct oral anticoagulants* (DOACs) are now recommended as as first line treatment for DVT. The clinical presentation and course of major and CRNM bleeds were similar in apixaban and enoxaparin/warfarin treated patients. [34] than in our VTE series. All patients undergoing surgery should be offered mechanical prophylaxis unless otherwise contraindicated; mechanical prophylaxis (antiembolic stockings) should not be used in patients with peripheral arterial disease, peripheral oedema, or local skin conditions. [Epub ahead of print DOI: 10.1136/thoraxjnl-2011-200416], Pulmonary embolism in respiratory failure, Clinical suspicion of fatal pulmonary embolism, Pulmonary embolism in patients with chronic obstructive pulmonary disease or congestive heart failure, Clinical predictors for fatal pulmonary embolism in 15,520 patients with venous thromboembolism: findings from the Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) Registry, Predictive variables for major bleeding events in patients presenting with documented acute venous thromboembolism. Venous thromboembolism (VTE) is a term used to describe both deep vein thrombosis (DVT) and pulmonary embolism (PE) – disorders caused by thrombus formation.. All patients being admitted to the hospital or undergoing surgery should be assessed for VTE risk on admission and re-assessed within 24 hours or if a change occurs in the clinical situation. Table 3shows the clinical presentation of VTE. The classic clinical presentation of DVT includes swelling, pain, warmth, and redness in the involved extremity. Other causes include a right-sided mural thrombus (e.g. The leg is swollen and red. Deep venous thrombosis (DVT) classically produces pain and limb edema; however Deep vein thrombosis (DVT) occurs when a blood clot (thrombus) forms in one or more of the deep veins in your body, usually in your legs. The number of VTE events and associated morbidity and mortality, Incidence of venous thromboembolism: a community-based study in Western France. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. Clinical presentation for both PE and DVT are listed in Table 2. Venous thromboembolism is a common complication among hospital inpatients and contributes to longer hospital stays, morbidity, and mortality. post-MI), atrial fibrillation (AF), neoplastic cells, or from fat cells (e.g. Lower extremity venous thromboembolism (VTE), including deep vein thrombosis (DVT) of the leg, is common. The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. The prevalence and incidence rate of all VTE was 5.6% and 6.3 per 1000 person years, respectively. By definition, all patients included presented symptomatic and objectively confirmed VTE. Online ISSN: 1399-3003, Copyright © 2021 by the European Respiratory Society. Hospitalized patients who have active malignancy and acute medical illness or reduced mobility should be offered pharmacologic thromboprophylaxis in the absence of bleeding or other contraindications (Type: evidence based; … Clinical presentation of VTE The most common symptom among patients diagnosed with VTE was swelling with pain, which was seen in 559 (68.8%) of the patients. This review summarizes the available information on the incidence, risk factors, clinical manifestations, and diagnosis of VTE in children beyond the neonatal period, excluding VTE in the central nervous system. Therefore, we cannot rule out a possible under diagnosis of PE in COPD patients, but this would rather strengthen our results. Clinical Presentation Type Signs and Symptoms Pulmonary embolism • Dyspnea • Palpitations • Pleuritic chest pain • Hemoptysis • Cyanosis/hypoxia in massive PE • Tachycardia • Tachypnea • Hypotension • Collapse • +/- symptoms or signs of DVT Deep vein thrombosis • DVT in pregnancy usually proximal • Unilateral leg pain/tenderness • Swelling in an extremity • Increase … The decision to monitor a patient in the inpatient or outpatient … Pineda et al. Venous thromboembolism (VTE) is a term used to describe both deep vein thrombosis (DVT) and pulmonary embolism (PE) - disorders caused by thrombus formation. A pulmonary embolism (PE) refers to a blockage of the pulmonary artery by a substance that has travelled there in the bloodstream. Evidence Review A systematic search was conducted in EMBASE Classic, EMBASE, Ovid MEDLINE, and other nonindexed citations using … We did not find any statistically significant difference in the risk of major bleeding between COPD and non-COPD patients, although such a difference has been evoked in smaller studies [27]. 1,3,4The diagnosis of VTE should be based on both clinical findings and diagnostic testing (UW Health GRADE High quality evidence, strong recommendation) 2. [34] and Gunen et al. Diagnosis of COPD was based solely on the clinical information available to the investigator. This lack of lung function tests is unfortunately shared by many studies on this topic [28–31]. [25] found that COPD patients diagnosed with PE were more likely to experience a longer delay before diagnosis than non-COPD patients. Therefore, we cannot exclude the possibility that some patients classified as having DVT in fact had asymptomatic and/or undiagnosed PE. We will practise performing VTE risk assessments using two cases at the end of the presentation. Objective To summarize the advances in diagnosis and treatment of VTE of the past 5 years.. Luque, O. Madridano, A. Maestre, V. Manzano, P.J. Patients with a mild clinical presentation (absence of viral pneumonia and hypoxia) may not initially require hospitalization, and most patients will be able to manage their illness at home. However, they were diagnosed according to the clinical practice of each participating centre. For example, data on lung function were available for only 28% of the patients included in a recent study of acute exacerbation of COPD [29]. Besides unprovoked presentation, other factors independently associated with a statistically significant increased risk of recurrent VTE are thrombophilia, clinical presentation with primary DVT, shorter duration of anticoagulation, and increasing age. [33] were more similar to ours, in terms of age and sex ratio, than those included in the studies of Tillie-Leblond et al. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Groupe d'Etude de la Thrombose de Bretagne Occidentale, Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC), Pulmonary embolism and deep venous thrombosis in hospitalized adults with chronic obstructive pulmonary disease, COPD and incident cardiovascular disease hospitalizations and mortality: Kaiser Permanente Medical Care Program, Chronic obstructive pulmonary disease and the risk of cardiovascular diseases, Cardiovascular disease in patients with chronic obstructive pulmonary disease, Saskatchewan Canada cardiovascular disease in COPD patients, Pulmonary embolism and mortality in patients with COPD, Causes of death in patients with COPD and chronic respiratory failure, Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism, Appropriateness of diagnostic management and outcomes of suspected pulmonary embolism, Adequate use of pulmonary embolism clinical prediction rule in COPD patients, Clinically suspected acute pulmonary embolism: a comparison of presentation, radiological features and outcome in patients with and without PE, The diagnosis of acute pulmonary embolism in patients with chronic obstructive pulmonary disease. We also express our gratitude to Bayer Pharma AG for supporting this Registry. The authors would like to thank S. Laporte (St-Etienne, France) and A. Perrier (Geneva, Switzerland) for their intellectual input and critical revisions, and all RIETE members for including patients. Feasibility of recruiting these children in EINSTEIN-Jr. phase III, a randomized trial evaluating rivaroxaban versus standard anticoagulation for VTE, was assessed. *DOACs include direct factor Xa inhibitors apixaban, rivaroxaban, and edoxaban, and a direct thrombin inhibitor, dabigatran. Therefore, efforts to improve thromboprophylaxis use are needed. Important components for the clinical diagnosis of VTE include risk factors such as immobilization, presence of cancer, confinement to bed, previous major surgery, prior VTE and – specific for DVT – whole limb enlargement, one-sided calf enlargement and dilatation of superficial veins. Arcelus, M.P. Elsewhere, links between obesity, adipokines and the abnormal inflammatory response seen in COPD are currently debated [38] and the potential effect of these interactions on pro-thrombotic states in COPD patients deserves further research. We also thank the Registry coordinating centre (S and H Medical Science Service, Madrid, Spain) for their quality control, and logistical and administrative support. In PE cases, the most common presentations were dyspnea in 33 (80.48%) cases, and chest pain in 27 (65.85%) cases. It is possible that PE was more frequently searched for (and found) in COPD patients. Rodríguez-Dávila, M. Román, P. Román, B. Román-Bernal, V. Rosa, S. Rubio, J. Ruíz, A. Ruiz-Gamietea, N. Ruiz-Giménez, J.C. Sahuquillo, A. Samperiz, R. Sánchez, J.F. Abstract The incidence of venous thromboembolism (VTE) in adult patients with sickle cell disease (SCD) is high. He has written extensively about VTE prophylaxis and is a proponent of using IPC in clinical … All patients being admitted to the hospital or undergoing surgery should be assessed for VTE risk on admission and re-assessed within 24 hours or if a change occurs in the clinical situation. Moreover, COPD patients were older than non-COPD patients, and this may also account for the differences. This article has supplementary material available from www.erj.ersjournals.com. 2 Rates of recurrent VTE range from 20% to 36% during the 10 years after an initial event. Pedrajas, R. Rabuñal, A. Riera-Mestre, M.A. However, the chronicity and variability of symptoms, as well as the frequent exacerbations, may conversely decrease the suspicion of PE in some COPD patients. Patients may, therefore, have been misclassified as COPD or non-COPD. For those with suspected PEs causing haemodynamic compromise, thrombolysis may be warranted however will require input from medical and intensive care teams. The absolute rate of recurrent VTE was 3.4% lower with edoxaban, whereas the absolute rate of major bleeding was 2.9% higher. Track how long patients wear their devices. Nieto, J.L. Furthermore, we could not subdivide COPD patients according to different stages of severity. Recommendation 1.1. Clinical Question 1. The clinical presentation of VTE, namely pulmonary embolism (PE) or deep venous thrombosis (DVT), and the outcome at 3 months (death, recurrent VTE or bleeding) were … Venous thromboembolism (VTE), encompassing pulmonary embolism (PE) and deep venous thrombosis (DVT), is a major cause of morbidity and mortality. Practise performing VTE Risk Assessments. classification of undiagnosed COPD patients as non-COPD patients) than over diagnosis [32]. We express our gratitude to Sanofi-Aventis Spain for supporting this Registry with an unrestricted educational grant. The higher rate of minor bleeding may be explained by the co-prescription of drugs such as steroids or anti-platelets, which may increase the bleeding risk in COPD patients. To further complicate matters, the rules for coding VTE … Prophylaxis is typically continued until the patient is no longer considered to be at significant risk of VTE. Arcos, R. Barba, M. Barrón, A. Blanco-Molina, J. Bosco, T. Cámara, M. Calvo, I. Casado, J.M. Ultrasonic Doppler and venographic techniques have shown deep vein thrombosis of the … 1 The incidence rate for DVT ranges from 88 to 112 per 100 000 person-years. Characteristic signs of pulmonary embolism include tachycardia (>100/min) and tachypnea (>20 breaths per minute), and – of course – clinical signs of deep vein thrombosis. We do not capture any email address. Findings from the RIETE Registry, Negative impacts of unreported COPD exacerbations on health-related quality of life at 1 year, Trends in chronic obstructive pulmonary disease prevalence, incidence, and mortality in Ontario, Canada, 1996 to 2007: a population-based study, Obesity as a risk factor in venous thromboembolism, COPD as a multicomponent disease: inventory of dyspnoea, underweight, obesity and fat free mass depletion in primary care, Enfermedad pulmonar obstructiva cronica en pacientes con tromboembolia de pulmon aguda sintomatica [Chronic obstructive pulmonary disease in patients with acute symptomatic pulmonary embolism], Prognostic factors for pulmonary embolism: the prep study, a prospective multicenter cohort study, The natural course of hemodynamically stable pulmonary embolism: clinical outcome and risk factors in a large prospective cohort study, Diagnosing acute pulmonary embolism: effect of chronic obstructive pulmonary disease on the performance of D-dimer testing, ventilation/perfusion scintigraphy, spiral computed tomographic angiography, and conventional angiography. VTE is one of the leading causes of preventable death in hospitals and is a important topic for juniors doctors to understand. Ogea, M. Oribe, R. Otero, J.M. Recommendations. The members of RIETE are as follows. Clinicians from 12 institutions retrospectively evaluated the presentation, therapeutic management, and outcome of VTE in children younger than 2 years seen in 2011–2016. Using data from the international RIETE (Registro Informatizado Enfermedad Trombo Embó … The presence of syncope, current DVT, hemoptysis, leg swelling, active cancer, surgery, leg pain, and shock each marginally increases the probability of PE. Moreover, the pulmonary arteries of COPD patients are characterised by endothelial cell dysfunction [39] and the hypothetical COPD-related pro-thrombotic status may predominate with regard to the pulmonary vascular bed, leading to in situ thrombosis [40]. At least 6 months, consider indefinite (Class I Level A) At least months;consider long term if risk benefit favors (2B) Recurrent VTE Long term (Grade 1B). The key clinical features of a PE are sudden onset dyspnoea, pleuritic chest pain, cough, or (rarely) haemoptysis. Given the risks associated with untreated lower extremity DVT (eg, fatal pulmonary emboli) and the risk of anticoagulation (eg, life-threatening bleeding), accurate diagnosis of DVT is essential. Anticoagulation treatment should be continued for 3 months in those with a provoked DVT, however in those with a proximal DVT and a persistent risk factor or high risk of DVT recurrence may require lifelong anticoagulation, Whilst around 10% of DVT patients are subsequently diagnosed with a malignancy, there is no benefit for extensive screening for occult malignancy in patients with unprovoked DVT, outside of history & examination, basic blood tests, and age-appropriate cancer screening investigations. Recent studies established that COPD may induce an additional specific pro-thrombotic biological situation, particularly during acute exacerbation of COPD [36,37]. Concerning outcome during the 3-month follow-up, the higher mortality in the COPD group is in accordance with previous studies, in which COPD was associated with a poorer prognosis [26]. Torres, J. Trujillo, F. Uresandi, M. Valdés, V. Valdés, R. Valle, G. Vidal, J. Villalta and V. Zorrilla; France: L. Bertoletti, A. Bura-Riviere, P. Debourdeau, I. Mahe and K. Rivron-Guillot; Greece: M. Papadakis; Israel: B. Brenner and D. Zeltser; Italy: A. Barillari, G. Barillari, M. Ciammaichella, P. Di Micco, F. Dalla Valle, R. Duce, R. Maida, S. Pasca, C. Piovella, R. Poggio, P. Prandoni, R. Quintavalla, A. Rocci, A. Schenone, E. Tiraferri, D. Tonello, A. Visonà and B. Zalunardo; Republic Of Macedonia: M. Bosevski; Switzerland: H. Bounameaux and M. Righini. The most common clinical presentation in the DVT cases was a Figure 1. Chronic obstructive pulmonary disease (COPD) is a moderate risk factor for venous thromboembolism (VTE), but neither the clinical presentation nor the outcome of VTE in COPD patients is well known. However, if we consider that PE may sometimes be an in situ thrombosis rather than an embolic complication of a DVT, placement of a vena cava filter might not be appropriate in the former case. Sánchez Muñoz-Torrero, S. Soler, M.J. Soto, G. Tiberio, J.A. Treatment with higher efficiency on recurrence risk but with no increase in bleeding risk deserves further evaluation. Venous thromboembolism (VTE) is a term used to describe both deep vein thrombosis (DVT) and pulmonary embolism (PE) – disorders caused by thrombus formation. If you do not agree to the foregoing terms and conditions, you should not enter this site. Enter multiple addresses on separate lines or separate them with commas. Is our article missing some key information? This finding should reassure physicians and patients that even in the absence of a specific reversal agent, apixaban is a convenient and safe choice for VTE. L. Bertoletti was supported by a research grant from Collège des Enseignants de Pneumologie. 1. Indefinite Class I Level A). Once you've finished editing, click 'Submit for Review', and your changes will be reviewed by our team before publishing on the site. Dabigatran and edoxaban require initial treatment with low molecular weight heparin (LMWH) (>5 days) before commencement of the DOAC, whereas rivaroxaban and apixaban do not. Bayer Pharma AG’s support was limited to the part of RIETE outside Spain, which accounts for a 13.39% of the total patients included in the RIETE Registry. We confirmed that PE is more frequently diagnosed in COPD patients, and that such patients have a poorer prognosis than non-COPD patients, with higher rates of mortality and minor bleeding. European Respiratory Society442 Glossop RoadSheffield S10 2PXUnited KingdomTel: +44 114 2672860Email: journals@ersnet.org, Print ISSN:  0903-1936 Review of the literature and future perspectives, Pulmonary vascular involvement in chronic obstructive pulmonary disease, Central pulmonary artery lesions in chronic obstructive pulmonary disease: a transesophageal echocardiography study, Screening for pulmonary arterial hypertension in adults carrying a, Childhood maltreatment and lung function: Findings from the general population, Longitudinal Course of Clinical Lung Clearance Index in Children with Cystic Fibrosis, Metered cryospray for patients with chronic bronchitis in COPD, Day-to-day variability of forced oscillatory mechanics in COPD, www.erj.ersjournals.com/site/misc/statement.xhtml. Of note, the prevalence of obesity in our COPD patients with VTE was two-fold higher than that observed in a large primary care population of European patients with COPD [24]. By visiting this site you agree to the foregoing terms and conditions. The cloud of pulmonary embolism during COPD exacerbation. Clinical Presentation The signs and symptoms of acute PE are at best nonspecific. Improve VTE Care and Prevention. Undiagnosed recurrent PE may explain, in part, the high rate of mortality due to PE. [17] found that COPD was associated with a higher risk of unsuspected fatal PE. Marchena, J.J. Martín-Villasclaras, M. Monreal, R. Monte, M. Morales, S. Muñoz, M.D. Interestingly, more aggressive treatment, such as thrombolytics or inferior vena cava filters, have been less frequently used in COPD patients with VTE. Remember to examine for any signs of DVT in any patient with suspected PE. This clinical classification is nevertheless frequently employed, even in randomised controlled therapeutic trials. However, overlapping features between the clinical presentation of VTE and SCD complications and a low index of suspicion for thrombosis can influence patient management decisions. Some venous thromboembolisms may be subclinical, whereas others present as sudden pulmonary embolus or symptomatic deep vein thrombosis. Recurrent PEs known secondary to recurrent DVTs, despite pharmacological management, should be considered for IVC filter. Spain: M. Alcalde, J.I. By Rudolf.hellmuth / CC BY-SA (https://creativecommons.org/licenses/by-sa/3.0), By James Heilman [CC BY-SA 3.0], via Wikimedia Commons, By James Heilman, MD [CC BY-SA 3.0], via Wikimedia Commons, [caption id="attachment_13304" align="aligncenter" width="359"], [caption id="attachment_13393" align="alignright" width="200"], [caption id="attachment_13310" align="aligncenter" width="400"], Endovascular Abdominal Aortic Aneurysm Repair, This is the most common underlying cause of a DVT, Hormone replacement therapy or the combined oral contraceptive pill, Known thrombophilia disorder (e.g. Sometimes a person with a PEwill pass out from the PE. L. Bertoletti would like to thank the “Collège des Enseignants de Pneumologie” who provided a research grant. In addition, results of lung function tests were not available for all our COPD patients. 75 Tolodí, C. Tolosa, M.I. The purpose of this presentation is to provide an introduction to venous thromboembolism and how to assess and manage VTE risk using the ED adult VTE risk assessment tool. However, the prevalence of COPD in the RIETE registry is similar to that in general settings [32], as mentioned previously. Deep vein thrombosis can cause leg pain or swelling, but also can occur with no symptoms.Deep vein thrombosis can develop if you have certain medical conditions that affect how your blood clots. include a sudden onset of chest pain, shortness of breath (breathing very fast) and increased heart rate. 121 (77.1%) VTE were unprovoked, 122 (77.7%) occurred in outpatients and 78 (60.9%) in patients with active disease. Moreover, COPD is usually underdiagnosed so if there was any misclassification, this would be under diagnosis (i.e. Importantly, 65% of DVTs are asymptomatic. Complaints related to … Use the information in this article to help you with the answers. Revisions: 40. LMWH alone is recommended in patients with cancer-associated VTE, due to lower recurrence rates than on Warfarin. *Less commonly, a PE may present on ECG with a right bundle branch block (RBBB), RV strain (inverted T waves in V1-V4 and / or leads AvF-III), or a rare S1Q3T3 (deep S wave in Lead I, pathological Q wave in Lead III, and inverted T wave in Lead III), Figure 3 – CTPA scan showing a large pulmonary embolism at the bifurcation of the pulmonary artery. DVT (uni-lateral) PE . Thank you for your interest in spreading the word on European Respiratory Society . Figure 2 – Deep vein thrombosis in the right leg. Besides unprovoked presentation, other factors independently associated with a statistically significant increased risk of recurrent VTE are thrombophilia, clinical presentation … Should hospitalized patients with cancer receive anticoagulation for VTE prophylaxis? Finally, more aggressive VTE treatments, such as thrombolytics or placement of a vena cava filter, have been proposed for COPD patients, particularly those presenting with DVT [30], but we found them to be less frequently used in our COPD patients. This difference is already present at day 7, mainly because of PE-related death. There are two main methods of thromboprophylaxis used in hospital: Try again to score 100%. Obesity is a well-known risk factor for VTE [23]. Sign In to Email Alerts with your Email Address, Clinical presentation and outcome of venous thromboembolism in COPD, Patient characteristics at baseline, thrombosis risk factors and index venous thromboembolism (VTE) event for 2,984 chronic obstructive pulmonary disease (COPD), Venous thromboembolism (VTE) in Europe. Nauffal, J.A. If pulmonary embolism is suspected in a patient, the PE Wells’ Score should be calculated: An ECG should be performed due to the differential diagnosis of MI, however this most commonly shows no abnormalities or a sinus tachycardia*. m−2 in 30% of COPD patients with VTE. Caution is advised in those with chronic renal impairment or if taking potentially interacting medications. Most commonly, this blockage is a thrombosis that has broken off and migrated (such as from a DVT). antiphospholipid syndrome or Factor V Leidin), Intermittent pneumatic compression (IPC, more commonly used in theatre), Low molecular weight heparin (LMWH), unless poor renal function (eGFR<30) then consider unfractionated heparin (UFH), Venous thomboembolism (VTE) is a large cause of preventable death, A VTE risk assessment should be done on all patients, Patients at risk of VTE should be commenced on appropriate thromboprophylaxis, Patients with a confirmed VTE require prompt treatment with anticoagulants. Inferior vena cava filters might protect the reduced pulmonary vascular bed of COPD patients from PE, which constitutes the main presentation of VTE in COPD patients according to our results, without any increase in the bleeding risk. The patients included in the study of Rutschmann et al. Disseminated intravascular coagulation (DIC) is a late disease event in COVID-19 infection, is associated with multiple organ failure and should be treated as per standard guidance. Patients with VTE were older at IBD diagnosis than those without VTE (34.4±14.8years vs 32.1±14.4years, p=0.045), but did not differ regarding sex, underlying IBD and disease duration. An important part of the management of VTE is prophylaxis. Our study is the largest clinical study to date focusing on clinical presentation and outcome of VTE in COPD patients. Swelling Shortness of breath PE may also have been underestimated in COPD patients presenting with signs of DVT and acute respiratory symptoms, as respiratory symptoms are spontaneously attributed to COPD without any screening for PE. Casas, E. Cisneros, E. Chaves, F. Conget, C. Delgado, J. del Toro, M. Durán, C. Falgá, C. Fernández-Capitán, M. Ferreiro, C. Font, F. Gabriel, P. Gallego, F. García-Bragado, M. Guil, N. Guillém, J. Gutiérrez, M.J. Hermosa, L. Hernández, D. Hernández-Huerta, F. Hernández-Toboso, M.J. Jaras, D. Jiménez, S. Jiménez, M. Jiménez-Gil, R. Lecumberri, J.L. Table 2 1,2Common signs and symptoms of DVT and PE . Alternatively, DVT can occur asymptomatically. Other less common signs are pain with breathing, dizziness and anxiety. Although venous thromboembolism (VTE) is a leading cause of maternal mortality, there is a paucity of real-world clinical data on clinical presentation and management of VTE during pregnancy and postpartum period.