Management of Venous Thromboembolisms: Part I. The Consensus for Deep Vein Thrombosis.
Deep vein thrombosis (DVT) is a potentially catastrophic condition because thrombosis, left untreated, can result in detrimental pulmonary embolism. Yet in the absence of thrombosis, anticoagulation increases the risk of bleeding. In the existing literature, knowledge about the epidemiology of DVT is primarily based on investigations among Caucasian populations. There has been little information available about the epidemiology of DVT in Taiwan, and it is generally believed that DVT is less common in Asian patients than in Caucasian patients. However, DVT is a multifactorial disease that represents the interaction between genetic and environmental factors, and the majority of patients with incident DVT have either inherited thrombophilia or acquired risk factors. Furthermore, DVT is often overlooked. Although symptomatic DVT commonly presents with lower extremity pain, swelling and tenderness, diagnosing DVT is a clinical challenge for physicians. Such a diagnosis of DVT requires a timely systematic assessment, including the use of the Wells score and a D-dimer test to exclude low-risk patients, and imaging modalities to confirm DVT. Compression ultrasound with high sensitivity and specificity is the front-line imaging modality in the diagnostic process for patients with suspected DVT in addition to conventional invasive contrast venography. Most patients require anticoagulation therapy, which typically consists of parenteral heparin bridged to a vitamin K antagonist, with variable duration. The development of non-vitamin K oral anticoagulants has revolutionized the landscape of venous thromboembolism treatment, with 4 agents available,including rivaroxaban, dabigatran, apixaban, and edoxaban. Presently, all 4 drugs have finished their large phase III clinical trial programs and come to the clinical uses in North America and Europe. It is encouraging to note that the published data to date regarding Asian patients indicates that such new therapies are safe and efficacious. Ultimately, our efforts to improve outcomes in patients with DVT rely on the awareness in the scientific and medical community regarding the importance of DVT.


BACKGROUND
Combination therapy; Hypertension; α1-blocker.
General Clinical Research Center, Taipei Veterans General Hospital; School of Medicine, National Yang-Ming University;
Kang-Ling
KL
Wang
Division of Cardiology, Department of Internal Medicine, Heart Failure Center, Healthcare Center, Chang Gung Memorial Hospital; College of Medicine, Chang Gung University;
Pao-Hsien
PH
Chu
Department of Internal Medicine, National Cheng Kung University Hospital; College of Medicine, National Cheng Kung University;
Cheng-Han
CH
Lee
Division of Cardiology, Department of Internal Medicine, China Medical University Hospital; School of Medicine, China Medical University;
Pei-Ying
PY
Pai
Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital;
Pao-Yen
PY
Lin
Division of Cardiology, Shin Kong Wu Ho-Su Memorial Hospital;
Kou-Gi
KG
Shyu
Department of Emergency Medicine, National Taiwan University Hospital;
Wei-Tien
WT
Chang
Division of Cardiovascular Surgery, Cardiovascular Center, Far Eastern Memorial Hospital;
Kuan-Ming
KM
Chiu
Division of Cardiology, Department of Internal Medicine, Cheng Hsin General Hospital;
Chien-Lung
CL
Huang
Department of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital;
Chung-Yi
CY
Lee
Department of Internal Medicine, National Taiwan University Hospital;
Yen-Hung
YH
Lin
Department of Cardiology, Chang Gung Memorial Hospital; College of Medicine, Chang Gung University;
Chun-Chieh
CC
Wang
Division of Cardiology, Department of Internal Medicine; Kaohsiung Medical University Hospital;
Hsueh-Wei
HW
Yen
Division of Cardiology, Department of Internal Medicine, Cheng Hsin General Hospital;
Wei-Hsian
WH
Yin
Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital; Mackay Medical College;
Hung-I
HI
Yeh
General Clinical Research Center, Taipei Veterans General Hospital; School of Medicine, National Yang-Ming University;
Chern-En
CE
Chiang
Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital;
Shing-Jong
SJ
Lin
Division of Cardiology, Department of Internal Medicine, Heart Failure Center, Healthcare Center, Chang Gung Memorial Hospital; College of Medicine, Chang Gung University;
San-Jou
SJ
Yeh