[New criteria for the diagnostic and treatment of the deep vein thrombosis of the lower limbs].
The diagnosis of the deep vein thrombosis (DVT) based exclusively on its symptomatology and on the examination clinic is of few usefulness due to its small sensibility and especificity. However, its adequate combination with the presence of risk factors for the thrombosis, and the existence or not of an alternative diagnosis, it can be employed it to classify to the patients according to the forecast model clinic of DVT of Wells in two categories: high or probability decrease of suffering it. Their utilization in urgencies together with the determination of the D dimer (DD) will indicate us the need or not of accomplishing an echo -- Doppler, currently the complementary election test. The phlebography is maintained as "the gold test", though is reservation for certain cases. Unless exceptions, the heparins of under molecular weight have displaced the heparins not fractioned in the treatment of the disease, due to the series of inconvenients that present: complications hemorrhagics, thrombocytopenia, need of hospitalization and of biological control. It is possible, that in a future most or less next new antithrombotics, as the fondaparinux or the ximelagatran change substantially the treatment of the DVT. The indication of the thrombolysis is little accepted, due to the fact that the relationship risk -- benefit is not satisfactory. Though they are not exempt of complications, exist clean-looking situations in those which is indicated the placement of a filter in the inferior vein cava. An exception, they would be the thrombosis massive veins with gangrene risk phlegmasia cerulea dolens, in patient with under risk hemorrhagic. Finally, in the cases that developed ischemia venous, that generally appear in the occlusions most proximals -- iliac and inferior vein cava --, an effective option to re-establish the venous permeability would be the thrombectomy venous.
Gabriel Botella
F
F
Servicio de Medicina Interna, Hospital Clínico Universitario, Valencia. fgabrielbotella@hotmail.com
Labiós Gómez
M
M
D000925:Anticoagulants / Q000627:therapeutic use*; D000933:Antifibrinolytic Agents; D002986:Clinical Trials as Topic; D003937:Diagnosis, Differential; D005338:Fibrin Fibrinogen Degradation Products; D006801:Humans; D035002:Lower Extremity / Q000000981:diagnostic imaging* / Q000473:pathology; D017410:Practice Guidelines as Topic; D018608:Ultrasonography, Doppler; D020246:Venous Thrombosis / Q000175:diagnosis* / Q000188:drug therapy*
D000925:Anticoagulants; D000933:Antifibrinolytic Agents; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
Nuevos criterios para el diagnóstico y tratamiento de la trombosis venosa profunda de los miembros inferiores.