Results:

Major Diagnostic Advances:

1. Introduction of age-adjusted D-dimer thresholds and the clinical Pulmonary Embolism (PE) Rule-Out Criteria for ruling out PE without imaging low pretest probability scenarios.
2. Emergency physician performed prompt compression ultrasonography of the proximal veins has good overall diagnostic accuracy with the caveat of operator dependency.
3. Magnetic resonance venography may have a role in specific populations such as morbidly obese patients where compression ultrasonography is not feasible.
4. V/Q single-photon emission computed tomography (CT) is an emerging technology with potential diagnostic accuracy similar to CT angiogram in acute PE without using intravenous contrast, but is not ready for routine clinical practice yet.

Major Therapeutic Advances:

1. Graduated compression stockings are no longer recommended for post-thrombotic syndrome (PTS) prevention post-deep vein thrombosis (DVT), but only as therapy in symptomatic patients.
2. Recurrent VTE prevention management plan after an unprovoked first VTE differs by gender. First, unprovoked VTE in a male warrants indefinite anticoagulation in low bleeding risk scenarios. Serially measured D-dimer levels and HERDOO2 clinical decision rule can guide discontinuation of extended anticoagulation in female patients.
3. In patients with noncancer-provoked VTE, anticoagulation is recommended for 3 months. In patients with cancer-associated VTE, anticoagulation may be given until the cancer is cured. Direct oral anticoagulants (DOACs), edoxaban or rivaroxaban, are noninferior to low-molecular weight heparin in cancer patients.
4. Overall, DOACs are also noninferior to vitamin K antagonists (VKAs) for prevention of recurrent VTE in all-comers. VKAs are, however, preferred in patients with severe renal impairment or when significant drug-drug interactions exist with DOACs.
5. The 2016 American College of Chest Physicians guidelines suggest that ultrasound surveillance only is preferred over anticoagulation in isolated distal DVT patients to monitor for thrombus extension.
6. The ATTRACT trial suggested no benefit of routinely using catheter-directed pharmaco-mechanical thrombolysis (CDT) over anticoagulation alone in initial treatment of acute proximal DVT. CDT is currently only recommended in patients with threatened limb loss. Whether any other subgroup of DVT patients would benefit from CDT remains unknown.
7. Two-year PEITHO trial follow-up suggested no improvement in overall survival and right ventricular function with routine systemic thrombolysis in intermediate-risk PE patients. Systemic thrombolysis is currently reserved for high-risk unstable PE patients.
8. A recent trial suggested no benefit in survival and recurrent PE rates with using retrievable inferior vena cava (IVC) filters for 3 months over anticoagulation alone in severe acute PE patients. Currently, IVC filters may only be used in proximal DVT and PE patients with an absolute contraindication to anticoagulation.
9. New reversal agents for DOACs are now approved (idarucizumab for dabigatran; andexanet-alfa for apixaban and rivaroxaban). However, cessation of therapy and supportive care may be sufficient in most bleeding events with DOACs.
10. There is currently insufficient evidence to support the use of DOACs in patients with antiphospholipid syndrome, heparin-induced thrombocytopenia, or venous thrombosis at unusual sites, such as splanchnic vein thrombosis.
11. Lack of prospectively validated bleeding risk score is another current knowledge gap.