Treatment of venous thromboembolism.
This review provides meta-analytic data of studies aiming at improved treatment of deep vein thrombosis and pulmonary embolism. The introduction of low molecular weight heparin has considerably ameliorated the initial treatment of deep vein thrombosis, and should now be regarded as the treatment of choice for most patients with deep vein thrombosis. Oral anticoagulant treatment is presently considered safe and effective for the long-term treatment of venous thromboembolism, provided that the INR is maintained at 2.0-3.0. However, the optimal duration as well as the optimal intensity of anticoagulation have still to be determined. Patients with submassive pulmonary embolism should presently be treated with adjusted dose unfractionated heparin and coumarins. Studies determining the efficacy and safety of low molecular weight heparin in this condition deserve priority. Thrombolytic therapy should be restricted to patients with massive pulmonary embolism, unless safer methods of thrombolysis have been developed. Surgical embolectomy and catheter fragmentation of emboli seem alternative options but deserve further investigations.
ten Cate
J W
JW
Center for Thrombosis, Hemostasis, Atherosclerosis and Inflammation Research, Academic Medical Center, Amsterdam, The Netherlands.
Koopman
M M
MM
Prins
M H
MH
Büller
H R
HR
D000925:Anticoagulants / Q000627:therapeutic use; D002407:Catheterization, Swan-Ganz; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D003374:Coumarins / Q000627:therapeutic use; D017128:Embolectomy; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D015337:Multicenter Studies as Topic; D011655:Pulmonary Embolism / Q000209:etiology / Q000401:mortality / Q000628:therapy; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D015912:Thrombolytic Therapy; D013924:Thrombophlebitis / Q000150:complications / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome; D016306:Vena Cava Filters
D000925:Anticoagulants; D003374:Coumarins; D006493:Heparin