Treatment of venous thromboembolism

Abstract

Venous thromboembolism (VTE) is a disease entity composed of pulmonary embolism (PE) and deep vein thrombosis (DVT). Anticoagulation, initiated as soon as the diagnosis is suspected, is the treatment of choice. Traditionally, anticoagulation is started with intravenous heparin, and changed to warfarin for long-term treatment. The introduction of unmonitored, subcutaneously administered, low molecular weight heparin has resulted in shorter hospitalizations, reduced the incidence of major bleeding as a complication, and shifted the treatment of VTE for selected patients to the outpatient setting. Thrombolytic therapy has been recommended for patients with life-threatening PE. Technologic advances in catheter embolectomy and fragmentation permit clot resolution in patients in whom thrombolytic therapy is contraindicated. Inferior cava filters can be placed percutaneously in patients at high risk for VTE or those in whom anticoagulation is contraindicated. Because VTE is often clinically silent, prevention of VTE is therefore the most effective means to reduce associated morbidity and mortality. Strategies to prevent VTE have been studied and validated for specific clinical circumstances.