Screening with imaging tests
Although asymptomatic pulmonary embolism (PE) is treated similarly to symptomatic PE, asymptomatic PE is generally detected incidentally when imaging is performed for a specific indication, especially cancer staging.[6]Donadini MP, Dentali F, Squizzato A, et al. Unsuspected pulmonary embolism in cancer patients: a narrative review with pooled data. Intern Emerg Med. 2014 Jun;9(4):375-84.
http://www.ncbi.nlm.nih.gov/pubmed/24664519?tool=bestpractice.com
[19]Stevens SM, Woller SC, Baumann Kreuziger L, et al. Antithrombotic therapy for VTE disease: second update of the CHEST guideline and expert panel report. 2021 Dec;160(6):e545-608.
https://journal.chestnet.org/article/S0012-3692(21)01506-3/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/34352278?tool=bestpractice.com
Studies have explored the value of screening for asymptomatic PE with imaging in cancer patients, though more data is needed before adopting this into clinical practice.[196]Loftus JR, Hu Z, Morin BR, et al. Vascular imaging in the asymptomatic high-risk cancer population: a role for thrombosis screening and therapy management. J Ultrasound Med. 2022 Jan;41(1):225-36.
https://onlinelibrary.wiley.com/doi/epdf/10.1002/jum.15701
http://www.ncbi.nlm.nih.gov/pubmed/33772825?tool=bestpractice.com
Screening for asymptomatic PE should not be part of routine clinical care.
Thrombophilia screening
Screening for thrombophilia in patients who have not yet had a deep vein thrombosis (DVT) is not likely to be beneficial except in very rare circumstances (e.g., a known family history of antithrombin deficiency in a woman planning pregnancy).[61]Middeldorp S, Nieuwlaat R, Baumann Kreuziger L, et al. American Society of Hematology 2023 guidelines for management of venous thromboembolism: thrombophilia testing. Blood Adv. 2023 Nov 28;7(22):7101-38.
https://ashpublications.org/bloodadvances/article/doi/10.1182/bloodadvances.2023010177/495845/American-Society-of-Hematology-2023-Guidelines-for
http://www.ncbi.nlm.nih.gov/pubmed/37195076?tool=bestpractice.com
[197]Bates SM, Greer IA, Middeldorp S, et al. VTE, thrombophilia, antithrombotic therapy, and pregnancy. Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012 Feb;141(2 Suppl):e691S-736.
https://journal.chestnet.org/article/S0012-3692(12)60136-6/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/22315276?tool=bestpractice.com
Cancer screening
Routine screening for cancer, apart from assuring that all age-appropriate screening has been completed, is not currently recommended in patients with an unprovoked DVT.[182]Piccioli A, Lensing AW, Prins MH, et al. Extensive screening for occult malignant disease in idiopathic venous thromboembolism: a prospective randomized clinical trial. J Thromb Haemost. 2004 Jun;2(6):884-9.
https://www.jthjournal.org/article/S1538-7836(22)15798-3/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/15140122?tool=bestpractice.com
The prevalence of occult cancer was low among patients with a first unprovoked venous thromboembolism. Routine screening with computed tomography of the abdomen and pelvis did not provide a clinically significant benefit.[184]Carrier M, Lazo-Langner A, Shivakumar S, et al. Screening for occult cancer in unprovoked venous thromboembolism. N Engl J Med. 2015 Aug 20;373(8):697-704.
http://www.ncbi.nlm.nih.gov/pubmed/26095467?tool=bestpractice.com