Medical management of venous thromboembolic disease

Abstract

Venous thromboembolism (VTE) accounts for a significant amount of morbidity and mortality in the United States. The diagnostic and therapeutic management has never been so varied with the numerous options now available.My purpose is to briefly review epidemiology, pathogenesis, prophylaxis, diagnosis, and treatment of VTE, highlighting the important studies and consensus recommendations informing current clinical practice. Invasive, noninvasive, direct, and indirect diagnostic modalities are reviewed with an evidence-based theme.Certainly, all patients should undergo a rigorous prophylaxis risk assessment for which various pharmacologic and nonpharmacologic options are available with varied clinical efficacy and safety profiles.Unfractioned heparins, low molecular weight heparins (LMWH), and thrombolytic agents play different roles as we enter the next millennium. Optimal outcomes with high patient satisfaction can be achieved with appropriate use of LMWHs for both deep vein thrombosis and pulmonary emboli.

Figure 1

Algorithm for differential diagnosis of recurrent venous thromboembolism

Figure 2.

Algorithm for differential diagnosis of deep venous thromboembolism

Dr. Deitelzweig is the Head of Ochsner's Section on Hospital Based Internal Medicine