[Venous thrombosis--a diagnostic and therapeutic challenge].
OBJECTIVE
Venous thrombosis and embolism has been the target of intensive investigation in recent years. The growing importance of mortality and morbidity due to venous thromboembolism led to new diagnostic and therapeutic tools. The clinical diagnosis may be misleading and both false-negative and false-positive diagnoses are common, when only clinical signs and symptoms are considered.


METHODS
A major problem in the care of the patient is to establish the correct diagnosis. Studies show, that only Venography or Duplexsonography can clearify diagnosis. Risk factors for venous thromboembolism, propability calculations and consensus recommendations for diagnosis and therapy are presented.


RESULTS
Diagnosis. Diagnosis of deep vein thrombosis must be established by Duplexultrasound and/or venography. Special situations may need further investigation by CT-scan or NMR-tomography. No single clinical sign or combination of signs give enough sensitivity and specificity. In patients with thromboembolism without clear etiology, hypercoagulability, neoplasms, compression syndroms, vascultides and other conditions have to be excluded.


METHODS
Heparins are the standard-therapy. Low-molecular weight heparins may have some benefits over standard heparins in terms of side effects and handling. Coumarin therapy can be started immediately, if no invasive procedures are necessary and have to be continued for 4-12 months, in recurred events and/or hypercoagulability even life-long. Thrombolysis is restricted to very few patients (patients under the age of 50 with large thrombosis not older than 3-7 days and no contraindications). Surgical thrombectomy is even more restricted. Compression therapy should be obligatory in all patients with thromboembolism.


CONCLUSIONS
Thromboembolism is mainly a diagnostic challenge. The immediate start of the appropriate treatment may reduce embolism and thrombus formation, induce recanalisation and prevent post-thrombotic syndrom.
Spengel
F A
FA
Klinik Feldafing, Klinik für Innere Medizin, Angiologie, Phlebologie, Feldafing.
von Liebe
S
S
D003937:Diagnosis, Differential; D005260:Female; D006493:Heparin / Q000627:therapeutic use*; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D010690:Phlebography; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000628:therapy; D013923:Thromboembolism / Q000175:diagnosis* / Q000628:therapy; D015912:Thrombolytic Therapy / Q000379:methods*; D013924:Thrombophlebitis / Q000175:diagnosis* / Q000628:therapy; D014057:Tomography, X-Ray Computed; D018616:Ultrasonography, Doppler, Duplex
D006495:Heparin, Low-Molecular-Weight; D006493:Heparin