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Treatment of Deep Vein Thrombosis

Henry I. Bussey, Pharm.D.
August 2004

Review: Bates SM, Ginsberg JS. Clinical Practice. Treatment of Deep-Vein Thrombosis. New England Journal of Medicine 2004; 351(3):268-277.

This concise and authoritative review provides up to date information on risk factors for developing deep vein thrombosis (DVT), the basics of diagnosis, recommended initial anticoagulant treatment, the role of thrombolytic therapy, the controversy regarding the length and anticoagulation intensity of long-term therapy (or secondary prophylaxis), avoiding the post-thrombotic syndrome, and suggestions on which patients should be evaluated for a hypercoagulable state as well as the degree to which such conditions may increase the risk of recurrence.

Clinicians in the U.S. may be less inclined to initiate a hypercoagulable workup than the Canadian authors of this paper suggest. In the U.S., the value of identifying a hypercoagulable condition in a given patient may have to be balanced against the fact that documenting such a condition may make it difficult for the patient to maintain and/or secure reasonable health insurance. Additionally, although the article examines the value of using the presence of hypercoagulable conditions and gender to estimate the risk of recurrence, it does not include recent limited data that suggest that elevated d-Dimer levels and persistence of ultrasound abnormalities also may help identify individuals who are at greater risk of DVT recurrence once anticoagulation is discontinued.

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Wednesday, May 22, 2024