It is estimated that up to 50% of deep vein thromboses (DVTs) are asymptomatic or go undetected.

In autopsy-based studies, pulmonary embolism (PE) has been identified as the proximate cause or contributor to death in 15% to 30% of all patients.

Inadequately treated DVT involving the popliteal or more proximal leg veins is associated with a 20% to 50% risk of clinically relevant recurrence and is strongly associated with both symptomatic and fatal PE.

Upper extremity DVT (UEDVT), usually the result of either mechanical compression from anatomic abnormality or central or peripherally inserted central venous catheters, account for up to 6% of all cases of PE.

In untreated patients, death from PE occurs most frequently within 24 to 48 hours of initial presentation.

Predictive scoring rules combine patient history and exam elements with objective testing results and are recommended for the most efficient approach to DVT and PE diagnosis.

For suspected DVT involving the arms or legs, compression ultrasound is the preferred initial imaging test; screening in asymptomatic patients is less accurate.

D-dimer levels may be elevated by many acute disease states (including myocardial infarction, pneumonia, sepsis, disseminated intravascular coagulation, liver disease, malignancy, surgery, hemorrhage, and trauma). A positive D-dimer assay is of limited diagnostic use, whereas a negative test essentially excludes venous thromboembolism (VTE) (DVT and PE).

Consensus is lacking on management of isolated acute, provoked distal (i.e., calf) DVT. At minimum, re-imaging (twice weekly compression ultrasonography for 2 weeks) is advised.

Anticoagulation is the cornerstone of treatment for documented DVT and PE.

The placement of an IVC filter at the time of diagnosis of PE should be reserved for those with an absolute contraindication to anticoagulation.

Idiopathic distal or proximal DVT may be the initial presentation of occult malignancy, and appropriate history, physical examination, and screening tests should be performed to detect cancer at its earliest stage.