Structured approach to the patient referred for unexplained arterial thrombosis
| Step 1: Defining the clot . |
|---|
| Review of imaging report |
| Review of imaging studies with radiology |
| Was thrombotic event arterial or venous? |
| Is there evidence of atherosclerosis? |
| Is there a visible vessel wall abnormality? |
| Review of pathology specimens for evidence of atherosclerosis, vasculitis, etc. |
| Discussion of etiology with organ-specific specialist (cardiologist, neurologist, ophthalmologist, etc.) |
| Step 1: Defining the clot . |
|---|
| Review of imaging report |
| Review of imaging studies with radiology |
| Was thrombotic event arterial or venous? |
| Is there evidence of atherosclerosis? |
| Is there a visible vessel wall abnormality? |
| Review of pathology specimens for evidence of atherosclerosis, vasculitis, etc. |
| Discussion of etiology with organ-specific specialist (cardiologist, neurologist, ophthalmologist, etc.) |
| Step 2: Performing a diagnostic evaluation (details in Table 3) . |
|---|
| A. Is atherosclerosis present or are there atherosclerosis risk factors? |
| B. Has the heart been examined for a cardioembolic source? |
| C. Review of other potential thromboembolic causes |
| a. Medications or substance use |
| b. Systemic diseases |
| c. Vascular or anatomic disorders |
| D. Consideration of thrombophilia evaluation in younger patient without other causative etiology (details in Table 5) |
| Step 2: Performing a diagnostic evaluation (details in Table 3) . |
|---|
| A. Is atherosclerosis present or are there atherosclerosis risk factors? |
| B. Has the heart been examined for a cardioembolic source? |
| C. Review of other potential thromboembolic causes |
| a. Medications or substance use |
| b. Systemic diseases |
| c. Vascular or anatomic disorders |
| D. Consideration of thrombophilia evaluation in younger patient without other causative etiology (details in Table 5) |
| Step 3: Determining the management plan . |
|---|
| Literature search for up-to-date studies |
| Discussion with organ-specific specialist of best management |
| Consideration of the patient-specific balance between risk of recurrent thrombosis and risk of bleeding |
| Discussion with patient of the limitations of existing data; acknowledgment that antiplatelet and/or anticoagulation treatment decisions are often non-evidence based |
| Reevaluation of patient and antithrombotic therapy on a regular basis |
| Step 3: Determining the management plan . |
|---|
| Literature search for up-to-date studies |
| Discussion with organ-specific specialist of best management |
| Consideration of the patient-specific balance between risk of recurrent thrombosis and risk of bleeding |
| Discussion with patient of the limitations of existing data; acknowledgment that antiplatelet and/or anticoagulation treatment decisions are often non-evidence based |
| Reevaluation of patient and antithrombotic therapy on a regular basis |