# Talk:Deep vein thrombosis

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As part of a student assignment, feedback on DVT was posted on a user's talk page: [1]. I believe I have already addressed their concerns with regard to compression stockings, but I'll double check. Biosthmors (talk) 17:13, 30 December 2019 (UTC)

I think that "deep bone thrombosis" (dbt) is the same thing as deep vein thrombosis. I'm not sure, but here is some corroborating text:

About 297 results (0.27 seconds) 
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Featured snippet from the web
Deep bone thrombosis, which is clotting in the veins that can cause a range of leg pain – this can become a life threatening illness if not addressed.
...
Other symptoms of PAD include:

    numbness/tingling in the lower legs and feet.
    coldness in the lower legs and feet.
    ulcers or sores on the legs or feet that do not heal.

Leg Pain
https://www.viralegs.com › leg-pain

Web results
Causes of Deep Bone Thrombosis - Graphic Online
https://www.graphic.com.gh › Ghana news Headlines › Health
May 2, 2014 - Dear mirror doctor I am a very active 46-year-old man who drives to and from work with no problems. I noticed a gradual increase in the size of ...

Assessment 2 (1) | Thrombosis | Vein - Scribd
https://www.scribd.com › document › Assessment-2-1
Nov 20, 2017 - Deep vein thrombosis deep bone thrombosis (DVT) is a blood clot thrombosis in a major vein that usually develops in the legs and/or pelvis. 2.

Deep Vein Thrombosis - Its a real issue if you drive too much ...
https://uberpeople.net › Geographical › Australia › Sydney
Feb 21, 2016 - 20 posts - ‎18 authors
... abuse prescription drugs and are actually obese telling us all we have to live healthier. On the Deep bone Thrombosis thing just make sure if ...

Leg Pain
https://www.viralegs.com › leg-pain
Deep bone thrombosis, which is clotting in the veins that can cause a range of leg pain – this can become a life threatening illness if not addressed.

Myumaimah : http://myumaimah.com/
https://myumaimah.com.cutestat.com
... wear compression stockings, compression socks for sale, deep bone thrombosis, varicose vein clinic, jobst compression socks, vertical veins in legs, where to ...

The House That Hugh Laurie Built: An Unauthorized Biography ...
https://books.google.com › books
Paul Challen - 2010 - ‎Biography & Autobiography
Within a minute in their first diagnostic session, House has ruled out the schizophrenia as a cause of the deep bone thrombosis (dbt). Unlike his other patients, ...

Deep Bone Thrombosis is Sexy | Torn Flesh Records
https://tornfleshrecords.bandcamp.com › track › deep-bone-thrombosis-is-...
Deep Bone Thrombosis is Sexy by Torn Flesh Records, released 18 November 2013.

Cafe on the Edge of Outer Space - Page 1 - Google Books Result
https://books.google.com › books
Robert Appleton - 2008 - ‎Interstellar travel
It's a deep-bone thrombosis of stars and gravitational attraction. Body to body, orbit to orbit, me to her. We're cosmic trespassers, and I feel just as transparent as ...

The Complete Testament - Page 1011 - Google Books Result
https://books.google.com › books
BLA BLA BLA, WE COULD NOT STOP GIVING HIM HIS MEDICATION EVEN HE IS SHOWING SIGNS OF DEEP BONE THROMBOSIS, BUT BECAUSE WE ...

Dr. Sunder Narasimhan - General Surgeon - Book ... - Practo
https://www.practo.com › bangalore › doctor › sunder-narasimhan-vascula...
Rating: 88% - ‎154 votes - ‎Price range: ₹700 consultation fee
Filter placement for deep bone thrombosis. ○. Cerucial rib. ○. Thoracic Outlet Syndrome. ○. Arterial Duroubosis. ○. Arterial Occlusion. ○. Mesentric Ischemia.
From https://www.google.com/search?client=firefox-b-1-d&q=%22Deep+bone+thrombosis%22 --User123o987name (talk) 16:21, 31 December 2019 (UTC)

It seems to be a misunderstanding/misspelling by people who really mean deep venous thrombosis. Tellingly, there are only 216 Google hits on your search. Most of the hits are not written by healthcare professionals. I did not find the phrase at all in PubMed. Axl ¤ [Talk] 12:18, 2 January 2020 (UTC)

Greetings User:Graham Beards. After a long hiatus, I am back to working on this article, which you previously reviewed. Thank you. Because of your comment towards the bottom of Wikipedia:Peer review/Deep vein thrombosis/archive3, I did recently incorporate mention of stroke [2] and I have been researching the potential impact of heart failure. Regarding heart failure as a risk factor for DVT, I am not yet sure. My current opinion is limited by general internet access. A 2016 systematic review and meta-analysis (doi:10.1016/S2352-3026(15)00228-8), for example, states in the abstract "Many studies have investigated the association between venous thromboembolism and heart failure, but have yielded inconsistent findings" but then concludes "Heart failure is a common independent risk factor for venous thromboembolism". Yet it seems odd to cite this article to support the claim that heart failure is a risk factor for DVT because this study is limited to hospitalized patients, and hospitalization itself is already cited on the article as a DVT risk factor. Also, it could be the case that statistical significance for VTE is demonstrated by pooling DVT and PE data while the statistical significance for DVT might not yet be independently established. Similarly, I saw a 2019 study [3] where heart failure appears more correlated with isolated PE than DVT with or without PE, called DVT/PE in this study. While the 2016 meta-analysis suggested that their findings could be considered in future prophylaxis regimens, for what it's worth, the most recent 2018 clinical practice guidelines [4] (that the CDC prominently features on their website[5]) don't have any separate guidance on heart failure patients. I feel a bit lost in the weeds here, but at this point it doesn't seem like a firm fact to call heart failure a risk factor for DVT (unless we operate under the assumption that VTE risk factors are always DVT risk factors). So, should VTE risk factors be cited on the DVT article as DVT risk factors? Biosthmors (talk) 17:07, 2 January 2020 (UTC)
Perhaps we should just specify that the risk factors in this article are VTE risk factors and then that fixes this issue. Biosthmors (talk) 17:36, 2 January 2020 (UTC)

The prose of the "Causes" section more or less does this already, I'd say. Also, I did find a more recent open-access study that looked at this issue. It said that "Most, although not all, studies have identified HF as an important risk factor for VTE".[6] It looks like the answer is yes, but it appears to be still in the process of being sorted out by current research. Biosthmors (talk) 13:52, 4 January 2020 (UTC)
This study provides some related and interesting reading: "Atrial Fibrillation and Cause-Specific Risks of Pulmonary Embolism and Ischemic Stroke" J Am Heart Assoc. 2018 Jan 29;7(3). doi:10.1161/JAHA.117.006502 (freely available source) Biosthmors (talk) 18:15, 8 January 2020 (UTC)

economics: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4706477/
diagnosis Wells PS, Ihaddadene R, Reilly A, Forgie MA (January 2018). "Diagnosis of Venous Thromboembolism: 20 Years of Progress" (PDF). Annals of Internal Medicine. 168 (2): 131–140. doi:10.7326/M17-0291. PMID 29310137.
pathophysiology/causes/risk factors: Salvagno GL, Pavan C, Lippi G (September 2018). "Rare thrombophilic conditions". Annals of Translational Medicine. 6 (17): 342. doi:10.21037/atm.2018.08.12. PMC 6174195. PMID 30306081.{{cite journal}}:  CS1 maint: unflagged free DOI (link) however (Annals of Translational Medicine redirects to AME Publishing Company which currently says "It was included on Beall's list of predatory publishers, prior to the list being taken offline in January 2017")
nonadministration of in-hospital doses (also covered in a 2015 Wall Street Journal article I believe) Kreutzer L, Yang AD, Sansone C, Minami C, Saadat L, Bilimoria KY, Johnson JK (November 2019). "Barriers to Providing VTE Chemoprophylaxis to Hospitalized Patients: A Nursing-Focused Qualitative Evaluation". Journal of Hospital Medicine. 14 (10): 668–672. doi:10.12788/jhm.3290. PMID 31433769. and Owodunni OP, Lau BD, Streiff MB, Kraus PS, Hobson DB, Shaffer DL, Webster KLW, Kia MV, Holzmueller CG, Haut ER (February 2019). "What the 2018 ASH venous thromboembolism guidelines omitted: nonadministration of pharmacologic prophylaxis in hospitalized patients". Blood Advances. 3 (4): 596–598. doi:10.1182/bloodadvances.2018030510. PMC 6391662. PMID 30792188.
management: Bartholomew JR (December 2017). "Update on the management of venous thromboembolism". Cleveland Clinic Journal of Medicine. 84 (12 Suppl 3): 39–46. doi:10.3949/ccjm.84.s3.04. PMID 29257737.
FVL paradox: https://ashpublications.org/bloodadvances/article/3/21/3375/422724/Thrombus-stability-explains-the-factor-V-Leiden Biosthmors (talk) 02:24, 18 February 2020 (UTC)
long-term / extended / indefinite anticoagulation Kearon C, Kahn SR (January 2020). "Long-term treatment of venous thromboembolism". Blood. 135 (5): 317–325. doi:10.1182/blood.2019002364. PMID 31917402. Biosthmors (talk) 17:57, 4 February 2020 (UTC)

I am currently not sure if all authors are consistent with their definition for iliofemoral DVT. It appears it might either mean proximal DVT,(I previously cited doi:10.1016/S0140-6736(11)61875-8 to support this use but I'm now paywalled), a certain kind of bad proximal DVT that requires involvement of an iliac vein,[7], or something to be distingished from both femoropopliteal and distal DVT.[8] To be determined. Biosthmors (talk) 19:54, 20 January 2020 (UTC)

I've decided to go with the explicit definition provided in 2019 guidelines from Australia and New Zealand as this seems to be the most reliable source to cite so far (particularly since it defines iliofemoral DVT in the context of using catheter-directed thrombolysis). The article has been updated accordingly. Biosthmors (talk) 16:55, 22 January 2020 (UTC)

(Relevant diff, which I reverted.) I massively reworked the newly dubbed "Causes and risk factors" section yesterday by subsuming a risk factor subsection into the prose of the causes section. So I renamed the new mega-section "Causes and risk factors." I think this title works better than just picking one (Causes or Risk factors) because the first paragraph is all about causes and a lot of the prose talks about the interplay between specific risk factors and why they contribute to those causes. So in my mind the dual titles work well for this section. That being said, the article is in flux, and there's conceptual overlap with the aforementioned section and the Pathophysiology section. So maybe we'll ultimately find a new and improved re-organization of the text that makes this thread obsolete. Also, maybe I'm missing some collective wisdom. For what it's worth, it does seem like a sentence should be added that explains how DVT risk is conceptualized as multifactorial and begins once a threshold is reached. I recall seeing that in a review article, but I'm not sure if it is cited or not. Biosthmors (talk) 15:46, 28 January 2020 (UTC)

I've re-thought this, and I've changed it to just "Causes" since that seems to be the most common thing to do per Wikipedia:Manual_of_Style/Medicine-related_articles#Diseases_or_disorders_or_syndromes. I don't see a loss in quality by not having the word "risk factor" in the section title. Biosthmors (talk) 15:17, 30 January 2020 (UTC)

These images of venograms are interesting. But I don't know what they are showing, so I find it confusing. It should be explained if it is going to be used in the article, in my opinion. In other words, I have long found these images distracting and confusing. I moved them here for the time being, and I will ask the author if they will please assist. Biosthmors (talk) 01:18, 29 January 2020 (UTC)
After injecting contrast medium into a vein on the foot, the various vein groups on the lower leg and knee become visible in fluoroscopy. Dilatations of the veins are limited by valves. It can be seen in large sections that the contrast medium does not fill the entire vein, but rather flows around long-stretched thrombi.--Hellerhoff (talk) 19:37, 30 January 2020 (UTC)
Thank you Hellerhoff! Biosthmors (talk) 16:46, 31 January 2020 (UTC)
The image currently illustrating post-thrombotic syndrome is complicated by a large area of bruising. It is not ideal. I have searched using some methods at WP:Pictures for medical articles but no luck yet. If anyone has access to an image for post-thrombotic syndrome, that would be great, especially if it shows a healthy leg next to an affected one. Biosthmors (talk) 18:54, 30 January 2020 (UTC)
I did find one on flikr showing PTS with a prominent ulcer. It was from the UK VTE prevention program but it's copyrighted (2013) and it looks like that organization / initiative is quasi-defunct as their former website is no longer active. Biosthmors (talk) 17:59, 4 February 2020 (UTC)

Bed rest appears to be confined to the history books: "The second half of the [20th] century was characterized by the simplification of anticoagulant treatment, which allowed ambulatory treatment of the disease and the end of the bed‐rest dogma".[9] This explains why I trimmed[10] that content out of the treatment section, which was based on 10+ year old medical sources anyhow. The article already establishes that bed rest is a risk factor (causes section) and that walking helps (prevention section). There's plenty of room to discuss bed rest as a historical treatment in the historical section, as the above quoted source does. But there's no need for us to carp to a few hold-out physicians of the 1990s, as it appears the former text was trying to do. Biosthmors (talk) 18:36, 4 February 2020 (UTC)

I cited a recent secondary source for content regarding aspirin. The following studies were previously cited in the DVT article, but I commented them out a while back, and I'm not sure we need to cite them. Perhaps listing them here will help make sure the article is comprehensive:

Stewart DW, Freshour JE (January 2013). "Aspirin for the prophylaxis of venous thromboembolic events in orthopedic surgery patients: a comparison of the AAOS and ACCP guidelines with review of the evidence". The Annals of Pharmacotherapy. 47 (1): 63–74. doi:10.1345/aph.1R331. PMID 23324504.
Warkentin TE (November 2012). "Aspirin for dual prevention of venous and arterial thrombosis". The New England Journal of Medicine. 367 (21): 2039–41. doi:10.1056/NEJMe1211480. PMID 23121404.
Simes J, Becattini C, Agnelli G, Eikelboom JW, Kirby AC, Mister R, et al. (INSPIRE Study Investigators (International Collaboration of Aspirin Trials for Recurrent Venous Thromboembolism)) (September 2014). "Aspirin for the prevention of recurrent venous thromboembolism: the INSPIRE collaboration". Circulation. 130 (13): 1062–71. doi:10.1161/circulationaha.114.008828. PMID 25156992. article states recurrent VTE after unprovoked VTE and discontinuation of VKA is about 10% in the first year and about 5% per year thereafter
Biosthmors (talk) 15:50, 18 February 2020 (UTC)

Is still commonly used especially in regions that do not have access to newer / more expensive agents. It is still an appropriate treatment and thus IMO should remain mention as such in the lead. Doc James (talk · contribs · email) 20:34, 26 February 2020 (UTC)

Warfarin is the most commonly prescribed anticoagulant in the UK [11].Graham Beards (talk) 20:53, 26 February 2020 (UTC)
That's fine by me. For what it's worth, I do wonder what the new NICE guidelines (with their planned release on 31 March 2020[12]) will say. Biosthmors (talk) 22:29, 26 February 2020 (UTC)
Much of the wealthy world is switching to the newer agents (because the easier). It will be a long time before this will occur for other regions were cost is a more significant factor.
Happy for us to mention that warfarin is generally started with heparin. Just shortened a bit. Doc James (talk · contribs · email) 18:23, 27 February 2020 (UTC)
Great. And I further clarified things according to my understanding. Biosthmors (talk) 12:12, 28 February 2020 (UTC)
That NICE guideline was published and it replaces and updates the currently cited NICE guideline the article uses, so that's something to update. Biosthmors (talk) 01:34, 5 May 2020 (UTC)

Guideline updated here. Need to review references to CG144 and replace. JFW | T@lk 09:57, 5 May 2020 (UTC)

Agreed! That's on my to-do list. Thanks for posting. Biosthmors (talk) 00:55, 7 May 2020 (UTC)

 A discussion is taking place to address the redirect Deep vein thrombosis in lower limb (NOS). The discussion will occur at Wikipedia:Redirects for discussion/Log/2020 July 13#Deep vein thrombosis in lower limb (NOS) until a consensus is reached, and readers of this page are welcome to contribute to the discussion.  Tom (LT) (talk) 06:58, 13 July 2020 (UTC)

Here we can list sources that might be useful for an updated pathophysiology section:

Nicklas JM, Gordon AE, Henke PK (March 2020). "Resolution of Deep Venous Thrombosis: Proposed Immune Paradigms". International Journal of Molecular Sciences. 21 (6). doi:10.3390/ijms21062080. PMC 7139924. PMID 32197363.{{cite journal}}:  CS1 maint: unflagged free DOI (link)
Ignore highlighting. Henke PK publishes widely in respected journals in this topic area [13]
Branchford BR, Carpenter SL (2018). "The Role of Inflammation in Venous Thromboembolism". Frontiers in Pediatrics. 6: 142. doi:10.3389/fped.2018.00142. PMC 5974100. PMID 29876337.{{cite journal}}:  CS1 maint: unflagged free DOI (link) cited & ignore highlighting: cited 72 times in Web of Science as of ~April 1, 2021
Thålin C, Hisada Y, Lundström S, Mackman N, Wallén H (September 2019). "Neutrophil Extracellular Traps: Villains and Targets in Arterial, Venous, and Cancer-Associated Thrombosis". Arteriosclerosis, Thrombosis, and Vascular Biology. 39 (9): 1724–1738. doi:10.1161/ATVBAHA.119.312463. PMID 31315434. cited
Laridan E, Martinod K, De Meyer SF (February 2019). "Neutrophil Extracellular Traps in Arterial and Venous Thrombosis". Seminars in Thrombosis and Hemostasis. 45 (1): 86–93. doi:10.1055/s-0038-1677040. PMID 30634198. cited
Najem MY, Couturaud F, Lemarié CA (May 2020). "Cytokine and chemokine regulation of venous thromboembolism". Journal of Thrombosis and Haemostasis : JTH. 18 (5): 1009–1019. doi:10.1111/jth.14759. PMID 32020753. cited
Fernandes CJ, Morinaga LTK, Alves JL, Castro MA, Calderaro D, Jardim CVP, et al. (March 2019). "Cancer-associated thrombosis: the when, how and why". European Respiratory Review. 28 (151). doi:10.1183/16000617.0119-2018. PMID 30918022.
Swystun LL, Liaw PC (August 2016). "The role of leukocytes in thrombosis". Blood. 128 (6): 753–62. doi:10.1182/blood-2016-05-718114. PMID 27354721. cited
Turetz M, Sideris AT, Friedman OA, Triphathi N, Horowitz JM (June 2018). "Epidemiology, Pathophysiology, and Natural History of Pulmonary Embolism". Seminars in Interventional Radiology. 35 (2): 92–98. doi:10.1055/s-0038-1642036. PMC 5986574. PMID 29872243. cited
Tzoran I, Hoffman R, Monreal M (October 2018). "Hemostasis and Thrombosis in the Oldest Old". Seminars in Thrombosis and Hemostasis. 44 (7): 624–631. doi:10.1055/s-0038-1657779. PMID 29920621.
Borgel D, Bianchini E, Lasne D, Pascreau T, Saller F (December 2019). "Inflammation in deep vein thrombosis: a therapeutic target?". Hematology. 24 (1): 742–750. doi:10.1080/16078454.2019.1687144. PMID 31736432. cited
Metz AK, Diaz JA, Obi AT, Wakefield TW, Myers DD, Henke PK (2018). "Venous Thrombosis and Post-Thrombotic Syndrome: From Novel Biomarkers to Biology". Methodist DeBakey Cardiovascular Journal. 14 (3): 173–181. doi:10.14797/mdcj-14-3-173. PMC 6217569. PMID 30410646.
Diaz JA, Saha P, Cooley B, Palmer OR, Grover SP, Mackman N, et al. (March 2019). "Choosing a Mouse Model of Venous Thrombosis". Arteriosclerosis, Thrombosis, and Vascular Biology. 39 (3): 311–318. doi:10.1161/ATVBAHA.118.311818. PMID 30786739. not needed
Li WD, Li XQ (August 2016). "Endothelial progenitor cells accelerate the resolution of deep vein thrombosis". Vascular Pharmacology. 83: 10–6. doi:10.1016/j.vph.2015.07.007. PMID 26187355.
Other topic: Jones T, Horner D (May 2017). "BET 2: Striking the right balance: anticoagulation and isolated distal deep vein thrombosis". Emergency Medicine Journal : EMJ. 34 (5): 334–336. doi:10.1136/emermed-2017-206732.2. PMID 28428437.
Recent reviews on mechanisms of cancer associated thrombosis also exist
Nasser NJ, Fox J, Agbarya A (February 2020). "Potential Mechanisms of Cancer-Related Hypercoagulability". Cancers. 12 (3). doi:10.3390/cancers12030566. PMC 7139427. PMID 32121387.{{cite journal}}:  CS1 maint: unflagged free DOI (link)
per https://www.scopus.com/sources.uri this journal is rated as 181/331 in oncology. a quick google search shows it has already been cited 17 times. Biosthmors (talk) 11:40, 23 April 2021 (UTC)
Biosthmors (talk) 21:36, 14 August 2020 (UTC)

Khan F, Tritschler T, Kahn SR, Rodger MA (May 2021). "Venous thromboembolism". The Lancet. doi:10.1016/S0140-6736(20)32658-1. PMID 33984268.
Ortel TL, Erkan D, Kitchens CS (September 2015). "How I treat catastrophic thrombotic syndromes". Blood. 126 (11): 1285–93. doi:10.1182/blood-2014-09-551978. PMID 26179082.
Is "'Idiopathic' catastrophic thrombosis" a synonym for thrombotic storm as currently used in 6th paragraph of this section?
Epidemiology: 

Wendelboe AM, Raskob GE (April 2016). "Global Burden of Thrombosis: Epidemiologic Aspects". Circ Res. 118 (9): 1340–7. doi:10.1161/CIRCRESAHA.115.306841. PMID 27126645.  cited
Raskob GE, Angchaisuksiri P, Blanco AN, Buller H, Gallus A, Hunt BJ, et al. (November 2014). "Thrombosis: a major contributor to global disease burden". Arterioscler Thromb Vasc Biol. 34 (11): 2363–71. doi:10.1161/ATVBAHA.114.304488. PMID 25304324. cited
Series of articles in Blood:

Kearon C, Kahn SR (January 2020). "Long-term treatment of venous thromboembolism". Blood. 135 (5): 317–325. doi:10.1182/blood.2019002364. PMID 31917402. cited, but this article can be expanded upon in terms of what anticoagulants for what condition. For example, when LMWH and not a DOAC?
Abbattista M, Capecchi M, Martinelli I (January 2020). "Treatment of unusual thrombotic manifestations". Blood. 135 (5): 326–334. doi:10.1182/blood.2019000918. PMID 31917405. cited
Moran J, Bauer KA (January 2020). "Managing thromboembolic risk in patients with hereditary and acquired thrombophilias". Blood. 135 (5): 344–350. doi:10.1182/blood.2019000917. PMID 31917425.
Weitz JI, Chan NC (January 2020). "Novel antithrombotic strategies for treatment of venous thromboembolism". Blood. 135 (5): 351–359. doi:10.1182/blood.2019000919. PMID 31917385.
Becattini C, Agnelli G (January 2020). "Acute treatment of venous thromboembolism". Blood. 135 (5): 305–316. doi:10.1182/blood.2019001881. PMID 31917399.
Random:

Zöller B, Svensson PJ, Dahlbäck B, Lind-Hallden C, Hallden C, Elf J (September 2020). "Genetic risk factors for venous thromboembolism". Expert Review of Hematology. 13 (9): 971–981. doi:10.1080/17474086.2020.1804354. PMID 32731838. cited
Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, et al. (January 2020). "2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)". European Heart Journal. 41 (4): 543–603. doi:10.1093/eurheartj/ehz405. PMID 31504429. cited
Chopard R, Albertsen IE, Piazza G (November 2020). "Diagnosis and Treatment of Lower Extremity Venous Thromboembolism: A Review". JAMA. 324 (17): 1765–1776. doi:10.1001/jama.2020.17272. PMID 33141212.
Wong E, Chaudhry S. "Venous thromboembolism (VTE)". McMaster Pathophysiology Review. Retrieved April 4, 2021.{{cite web}}:  CS1 maint: url-status (link)
Henke PK, Kahn SR, Pannucci CJ, Secemksy EA, Evans NS, Khorana AA, et al. (June 2020). "Call to Action to Prevent Venous Thromboembolism in Hospitalized Patients: A Policy Statement From the American Heart Association". Circulation. 141 (24): e914 – e931. doi:10.1161/CIR.0000000000000769. PMID 32375490.
Diagnosis:

Moore AJE, Wachsmann J, Chamarthy MR, Panjikaran L, Tanabe Y, Rajiah P (June 2018). "Imaging of acute pulmonary embolism: an update". Cardiovascular Diagnosis and Therapy. 8 (3): 225–243. doi:10.21037/cdt.2017.12.01. PMC 6039809. PMID 30057872.{{cite journal}}:  CS1 maint: unflagged free DOI (link)
Signs and symptoms:

Andreou ER, Koru-Sengul T, Linkins L, Bates SM, Ginsberg JS, Kearon C (October 2008). "Differences in clinical presentation of deep vein thrombosis in men and women". Journal of Thrombosis and Haemostasis. 6 (10): 1713–9. doi:10.1111/j.1538-7836.2008.03110.x. PMID 18665920.
Stubbs MJ, Mouyis M, Thomas M (March 2018). "Deep vein thrombosis". BMJ. 360: k1335. doi:10.1136/bmj.k1335. PMID 29563086.{{cite journal}}:  CS1 maint: article number as page number (link) mentions character of pain, exacerbating factors; also check BMJ citations there seems to be a problem with accurate volume numbers?
Lines of Zahn:

Grimes Z, Bryce C, Sordillo EM, Gordon RE, Reidy J, Paniz Mondolfi AE, et al. (2020). "Fatal pulmonary thromboembolism in SARS-CoV-2-infection". Cardiovascular Pathology. 48: 107227. doi:10.1016/j.carpath.2020.107227. PMC 7214296. PMID 32718733.{{cite journal}}:  CS1 maint: article number as page number (link)
Biosthmors (talk) 19:26, 17 March 2021 (UTC)

A recent edit[14] added the following text, which I just removed as I have concerns over too-close paraphrasing and duplicative content. Some of it however might be worth adding back "Venous blood clots are structures consisting of successive layers of fibrin, platelets, red bloods cells, and leukocytes. Compared to arterial clots, the number of platelets is relatively low, but platelets do seem to play an important role. It's also worth noting that the use of aspirin may decrease the risk of first and recurrent VTE." Biosthmors (talk) 17:20, 2 April 2021 (UTC)

This edit might have removed the answer but I haven't seen it discussed yet in more recent reviews. Biosthmors (talk) 18:39, 9 April 2021 (UTC)

In reply to this edit, I've seen a couple reviews mention soleal veins[15] / the soleal vein[16]. The second source discusses the soleal vein in depth. I thought mention of this vein / venous system and a WP:REDlink to it were appropriate. I was thinking since secondary sources mention it, we'd be fine to mention it as well (and that it deserved an article) User:Jfdwolff. Thanks. Biosthmors (talk) 14:42, 11 April 2021 (UTC)

Thanks for the clarification. The soleal veins are definitely not the only calf veins where DVTs can originate. From the second reference: "The deep veins of lower limbs are divided into the thigh and calf veins. The calf veins comprise three crural veins (posterior tibial, anterior tibial, and peroneal veins) that receive blood flow from the foot sole and the intramuscular veins (soleal and gastrocnemius veins) and their joint vein (popliteal vein). The thigh veins (iliac and femoral veins) run from the calf veins toward the center. The calf and thigh veins have different anatomical features." Therefore, we should either mention all the veins or none of them. JFW | T@lk 08:15, 12 April 2021 (UTC)
I agree with you that "the soleal veins are definitely not the only calf veins where DVTs can originate". But the source has an entire section on "Growth of a Soleal Vein Thrombus", for example. It doesn't do this with any other vein. The first source cites the second (and another) for its sentence that in "most of the lower extremity DVT cases, thrombus formation starts in the soleal veins of the calf and then propagates to other veins". I'm not sure a majority of LEDVT starts in the soleal vein, but saying they often start there appears to be an accurate and appropriately weighted claim. I'm not wedded to this mention of soleal vein(s), however. Biosthmors (talk) 01:17, 13 April 2021 (UTC)

I excised the following text: Anticoagulation, which increases the risk of bleeding, is sometimes used indefinitely (lifelong treatment) in those with a high-risk for recurrence. The risk of major bleeding with long-term anticoagulation is about 3% per year,<ref name="Varga"/> and the point where annual VTE risk is thought to warrant long-term anticoagulation is estimated to be between 3 and 9%.<ref name="Keeling"/> Usually, only when individuals exceed a 9% annual VTE risk is long-term anticoagulation a common consideration.<ref name="Keeling">{{cite journal | vauthors = Keeling D, Baglin T, Tait C, Watson H, Perry D, Baglin C, Kitchen S, Makris M | display-authors = 6 | title = Guidelines on oral anticoagulation with warfarin – fourth edition | journal = British Journal of Haematology | volume = 154 | issue = 3 | pages = 311–24 | date = August 2011 | pmid = 21671894 | doi = 10.1111/j.1365-2141.2011.08753.x | doi-access=free}}</ref> For example, antithrombin deficiency, a strong or moderately strong risk factor, carries an annual risk of VTE of only 0.8–1.5%;<ref name="Varga"/> as such, asymptomatic individuals with thrombophilia do not warrant long-term anticoagulation.<ref>[[#CITEREFGuyattAklCrowtherGutterman2012|Guyatt et al. 2012]], p. 11S: 7.1.</ref>  The logic of this text is predominantly based upon the use of warfarin. However, anticoagulation now, warfarin or DOACs, has more complicated and differing risk profiles. For example: "... the consequences of a major bleed are generally worse than the consequences of a recurrent VTE: about 12% of major bleeds (probably lower with direct oral anticoagulants [DOACs] than with warfarin10 ), as opposed to 4% of recurrent VTE, are fatal (∼3:1 ratio).3,9,11-13" From [17]. Biosthmors (talk) 06:33, 16 April 2021 (UTC)

I removed the following: Signs and symptoms alone are not sufficiently [[Sensitivity and specificity|sensitive or specific]] to make a diagnosis, but when considered in conjunction with [[#Diagnosis|pre-test probability]], can help determine the likelihood of DVT.<ref name=2019Tran/> and simplified the content for the signs and symptoms section. I'm currently thinking the diagnosis section should mention and link pre-test probability at the beginning. Biosthmors (talk) 15:38, 22 April 2021 (UTC)

The page refers to VTE that can relate to either DVT or PE which is backed up by ref used, but other refs and the entry page for VTE says that VTE is the combination of DVT and PE. This needs to be addressed maybe by adding 'some sources...' etc. 
--Iztwoz (talk) 09:50, 25 April 2021 (UTC)

Thank you for your edits Iztwoz. I see sources say that DVT and PE comprise VTE. But this just means (as I understand it) that VTE = either DVT, PE, or DVT + PE. I'm unaware of sources that say VTE is only DVT + PE. Even if we found one, I think the preponderance of sources are clear on this. With regards to this diff, the supporting sentence is "Thrombosis at unusual sites accounts for ∼10% of all cases of venous thrombosis, affecting any venous region other than the deep or superficial veins of the lower limbs or those involved in pulmonary circulation."[18] (And just to compare the incidence of superficial vein thrombosis with VTE I found this and they are comparable [both are around 1 to 2 per thousand person years].) I also made a clarifying edit at venous thrombosis. In an ideal world, perhaps there would be a parent article at venous thromboembolism for DVT, DVT + PE, and PE. The article at venous thrombosis should really be a parent article to all forms of venous thrombosis. I don't like the current venous thrombosis page because focuses too heavily on VTE, but I believe that's also (perhaps mainly) my fault. Biosthmors (talk) 11:37, 25 April 2021 (UTC)
Thanks Biosthmors I admit to a bias for defining venous thromboembolism as comprising both DVT and PE - as per Harrison's for one. A clot in a vein - DVT - is a clot in a vein....it is only a thromboembolism when it or part of it detaches and travels in the bloodstream or what am I misunderstanding?  That aside I feel that there is too much coverage of VTE and PE when the entry page is DVT.? These days I can only fit in a few edits mostly when am very tired. --Iztwoz (talk) 19:38, 25 April 2021 (UTC)
This is copied from Venous thrombosis page - "When a blood clot breaks loose and travels in the blood, this is called a venous thromboembolism (VTE). The abbreviation DVT/PE refers to a VTE where a deep vein thrombosis (DVT) has moved to the lungs (PE or pulmonary embolism).--Iztwoz (talk) 19:54, 25 April 2021 (UTC)
I understand the concern. In my mind it makes sense that Wikipedia might contradict itself, because sources appear to contradict one another as well. I found this public-facing website of an organization that hosts medical journals, and it says VTE = DVT + PE. (But would they agree if you pressed them that they really mean and/or?) I went to a new guideline-based journal article to see what they say and the first sentence says "Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is an important cause of morbidity and mortality among patients with cancer.": from Key NS, Khorana AA, Kuderer NM, Bohlke K, Lee AYY, Arcelus JI, et al. (February 2020). "Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO clinical practice guideline update". Journal of Clinical Oncology. 38 (5): 496–520. doi:10.1200/JCO.19.01461. PMID 31381464.. I've asked a couple Wikipedian physicians (one is already participating) to take a look at the ongoing peer review for DVT. Maybe they'll chime in. For what it's worth, NICE opts for the term venous thromboembolic diseases in reference to DVT and PE.[19] Thanks for your efforts! A lot of the data generated for DVT is under the rubric of VTE so yes, sometimes this article is more generalist than specific at times. Biosthmors (talk) 20:16, 25 April 2021 (UTC)
I looked up Harrison's (the same one?) and it said "Venous thromboembolism (VTE) encompasses deep venous thrombosis (DVT) and pulmonary embolism (PE)..."[20] I interpret that to mean DVT, PE, or DVT + PE. Hope this all helps. I hope you get some rest! Biosthmors (talk) 20:22, 25 April 2021 (UTC)
I read it as it says - VTE comprises DVT and PE, as other surces also say and this does not need anybody's interpretation. A pulmonary embolism on its own cannot be considered to be specifically a venous thromboembolism since it may also be caused by an air bubble or a part of an atherosclerotic plaque.see [21]--Iztwoz (talk) 12:17, 28 April 2021 (UTC)
Robbins makes the distinction of Pulmonary thromboembolism. Another way of looking at the definition is the description of a pulmonary embolism caused by a deep vein thrombosis.--Iztwoz (talk) 15:23, 28 April 2021 (UTC)
Changed wording a bit and added refs - I shall leave the rest now for JFW's review. Best--Iztwoz (talk) 17:06, 28 April 2021 (UTC)
I was looking for a journal article to replace the book/website references and the first journal article I opened prompted me to instead excise one of the contributions FYI. The rationale is in the edit summary. Best. Biosthmors (talk) 23:21, 2 May 2021 (UTC)

Prompted by Wikipedia:Peer review/Deep vein thrombosis/archive4, I removed the following text from the Classification section because I think it wouldn't be useful for readers. These distinctions are either hardly drawn or absent in the article: DVT that has no symptoms, but is found only by screening, is labeled asymptomatic or incidental.<ref name=airline/><ref name=2020Mulder>{{cite journal | vauthors = Mulder FI, Di Nisio M, Ay C, Carrier M, ((Bosch FTM)), Segers A, Kraaijpoel N, Grosso MA, Zhang G, Verhamme P, Wang TF, Weitz JI, Middeldorp S, Raskob G, ((Beenen LFM)), Büller HR, van Es N | display-authors = 6 | title = Clinical implications of incidental venous thromboembolism in cancer patients | journal = The European Respiratory Journal | volume = 55 | issue = 2 | pages = | date = February 2020 | pmid = 31727694 | doi = 10.1183/13993003.01697-2019 }}</ref>
And this will be a good source to help give context to the different classifications of proximal DVT: Jenkins JS, Michael P (2014). "Deep venous thrombosis: an interventionalist's approach". The Ochsner Journal. 14 (4): 633–40. PMC 4295740. PMID 25598728. Biosthmors (talk) 14:27, 13 May 2021 (UTC)

Pregnancy is associated with an increase in fibrinogen and D-dimer levels, so this test is less useful. This should probably be mentioned in the diagnosis section. I've heard of age-adjusted D-dimer levels in the workup of PE, but I don't recall ever seeing that applied to DVT. Biosthmors (talk) 17:52, 25 May 2021 (UTC)

I'm not sure this addition adds anything to the article. It's 9 years old, so it's likely outdated, and it doesn't add anything to the article in my opinion. I seriously doubt the recent seminar on VTE in the Lancet cited this article. The questions Cochrane articles attempt to answer (in my opinion) don't often cleanly lend themselves towards generating useful prose. This article has only been cited ~24 times in the last 9 years. Others seem to agree. Biosthmors (talk) 02:10, 4 August 2021 (UTC)

Selective estrogen receptor modulators can be added as a risk factor. Biosthmors (talk) 22:04, 1 August 2022 (UTC)

WP:MEDRS evidence? Zefr (talk) 02:37, 2 August 2022 (UTC)
Abounds Biosthmors (talk) 00:10, 5 August 2022 (UTC)
That's a 13 year old preliminary study. We use reviews - a MEDRS systematic review, meta-analysis, or position statement by a clinical organization within the past 5 years - see WP:MEDSCI. Don't think it exists - see this. Zefr (talk) 01:01, 5 August 2022 (UTC)
Zefr, I am familiar with how to source medical articles on Wikipedia. I saw this brought up in a practice board question, so I am assuming it is well-described in the literature. It makes sense, since it is well known that estrogen (think birth control types) increases the risk of VTE. I found a review that states the following regarding tamoxifen (a SERM): "Chemotherapy further heightened the risk of VTE (~ 10-fold higher compared to who did not receive chemotherapy) in patients with metastatic BC [8, 30]. Among hormonal therapies, tamoxifen carried the highest risk which could increase the risk of VTE up to sevenfold, followed by aromatase inhibitors [32]." I am not proposing any specific text for the article at this point. But tamoxifen being an established risk factor appears well-known, as it is mentioned in the abstract of doi:10.3390/cancers12030566 {{doi}}: unflagged free DOI (link). Also, the abstract of a 2015 review doi:10.1517/14740338.2015.1014799 states the risk is increased with most SERMs, so based on that I will concede that my original post is overly-simplistic and likely overstated. But still, the phenomenon I reference appears to be well-known. Biosthmors (talk) 19:46, 20 August 2022 (UTC)

An expert told me HHS was a risk factor today. I see it confirmed in Western populations thus far.[22] Biosthmors (talk) 23:38, 4 November 2022 (UTC)

VTE is a well-known complication of HHS (not just DVT). Should be easy to source. JFW | T@lk 09:50, 6 November 2022 (UTC)

ovarian hyperstimulation syndrome was mentioned as a risk factor for venous thrombosis. could add. Biosthmors (talk) 20:33, 18 December 2024 (UTC)
glucagonoma can be added. Biosthmors (talk) 16:02, 17 August 2025 (UTC)