[Therapy of venous thromboembolism]

Abstract

Deep venous thrombosis and lung embolism are often considered as two different variants of the same disease. This is evident not only in the same pathogenesis but also in a comparable prognosis and therapy. Therefore the term "venous thromboembolism" is used in recent literature. The main therapy of venous thromboembolism is anticoagulation and initially consists of (low molecular weight) heparin followed by a regimen with oral anticoagulants--the duration depending on the indication. Pharmacokinetic advantages of low molecular weight heparin (LMWH) allow weight-adapted dosing with daily subcutaneous injections in most patients. LMWH do not require any laboratory controls. Therefore outpatient treatment should be possible for about 75% of patients with venous thromboembolism. Outpatient treatment of lung embolism, however, is still being studied and therefore not recommended apart from clinical trials. In cases of massive venous thromboembolism additional treatment with thrombolytic agents or surgery is needed. Adequately fit compression stockings can reduce the risk of post-thrombotic syndrome after deep venous thrombosis. Patients on long-term oral anticoagulation may learn to measure their INR with a portable coagulation monitor and adjust the dosage of the anticoagulants themselves--this method is called patient self-management of oral anticoagulation.