Diagnosis and treatment of deep-vein thrombosis

Abstract

Deep-vein thrombosis (DVT) has an estimated annual incidence of 67 per 100 000 among the general populations.1,2 Despite adequate therapy, 1% to 8% of patients in whom pulmonary embolism develops will die, 3-5 whereas others will experience long-term complications such as postphlebitic syndrome (40%) 6 and chronic thromboembolic pulmonary hypertension (4%).7 Although anticoagulant therapy decreases the risk of recurrent thrombosis, the treatment also increases the risk of major hemorrhage. Before 1995 the approach was to image all patients with suspected DVT and to repeat tests 1 week later if results were negative. 8,9 This approach was inefficient, since only 10%-25% of patients with suspected DVT were found to actually have the disorder and results of serial tests were usually negative.9-12 Over the last 10 years new strategies for diagnosing and treating suspected DVT have been introduced.

Avaliação da tromboflebite jugular experimental em equinos tratados com heparina

“…As HBPM têm substituído a heparina não fracionada por possuírem menos efeitos indesejáveis como a resposta variável devido à ligação com proteínas plasmáticas ou a trombocitopenia induzida pela heparina (TIH) [1]. Além disso, diversos estudos realizados com modelos de trombose venosa em animais e estudos clínicos em humanos portadores de doenças venosas tromboembólicas mostraram que as HBPM são equivalentes ou até mesmo superiores à heparina não fracionada em relação ao seu efeito antitrombótico e possuem maior segurança por apresentar menor risco hemorrágico [5,14,17,18,19,20,21,22].…”

“…O fondaparinux e o idraparinux, dois novos agentes anticoagulantes parenterais usados em pacientes com tromboembolismo venoso e arterial, são pentassacarídeos sintéticos análogos à heparina, com alta afinidade com a antitrombina e potentes inibidores do fator Xa, que impedem a formação da trombina [1,16,21,23].…”

“…Estudos recentes relatam que o fondaparinux apresenta eficiência e risco hemorrágico similares aos observados com HBPM, com a vantagem de apresentar menor risco de trombocitopenia induzida pela heparina (TIH) [16,21,26,27,28].…”

Use of Percutaneous Aspiration Thrombectomy vs. Anticoagulation Therapy to Treat Acute Iliofemoral Venous Thrombosis: 1-year Follow-up Results of a Randomised, Clinical Trial

“…The annual incidence of DVT is 5-20 per 10,000 subjects [1,2]. Despite delivery of appropriate medical treatment, 1-8 % of patients die from secondary PEs [3]. During long-term follow-up, postthrombotic syndrome and chronic thromboembolic pulmonary hypertension develop in 40 and 4 % of patients, respectively [3].…”

Deep vein thrombosis and bilateral pulmonary embolism following minor trauma to the popliteal fossa: could this have been avoided?

“…DVT has an incidence of 66 per 100,000 per year, 1 and DVTs commonly occur in the popliteal and femoral veins. 2 From these sites, thrombi may embolize to the lungs. Pulmonary embolism (PE) will develop in approximately 50% of untreated DVT's, many of which will be asymptomatic.…”