Document Detail


DVT and pulmonary embolism: Part II. Treatment and prevention.
MedLine Citation:
PMID:  15222649     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Treatment goals for deep venous thrombosis include stopping clot propagation and preventing the recurrence of thrombus, the occurrence of pulmonary embolism, and the development of pulmonary hypertension, which can be a complication of multiple recurrent pulmonary emboli. About 30 percent of patients with deep venous thrombosis or pulmonary embolism have a thrombophilia. An extensive evaluation is suggested in patients younger than 50 years with an idiopathic episode of deep venous thrombosis, patients with recurrent thrombosis, and patients with a family history of thromboembolism. Infusion of unfractionated heparin followed by oral administration of warfarin remains the mainstay of treatment for deep venous thrombosis. Subcutaneously administered low-molecular-weight (LMW) heparin is at least as effective as unfractionated heparin given in a continuous infusion. LMW heparin is the agent of choice for treating deep venous thrombosis in pregnant women and patients with cancer. Based on validated protocols, warfarin can be started at a dosage of 5 or 10 mg per day. The intensity and duration of warfarin therapy depends on the individual patient, but treatment of at least three months usually is required. Some patients with thrombophilias require lifetime anticoagulation. Treatment for pulmonary embolism is similar to that for deep venous thrombosis. Because of the risk of hypoxemia and hemodynamic instability, in-hospital management is advised. Unfractionated heparin commonly is used, although LMW heparin is safe and effective. Thrombolysis is used in patients with massive pulmonary embolism. Subcutaneous heparin, LMW heparin, and warfarin have been approved for use in surgical prophylaxis. Elastic compression stockings are useful in patients at lowest risk for thromboembolism. Intermittent pneumatic leg compression is a useful adjunct to anticoagulation and an alternative when anticoagulation is contraindicated.
Authors:
Dino W Ramzi; Kenneth V Leeper
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  American family physician     Volume:  69     ISSN:  0002-838X     ISO Abbreviation:  Am Fam Physician     Publication Date:  2004 Jun 
Date Detail:
Created Date:  2004-06-29     Completed Date:  2004-07-22     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  1272646     Medline TA:  Am Fam Physician     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2841-8     Citation Subset:  AIM; IM    
Affiliation:
Emory University School of Medicine, Atlanta, Georgia, USA.
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MeSH Terms
Descriptor/Qualifier:
Anticoagulants / therapeutic use*
Humans
Pulmonary Embolism / etiology,  prevention & control,  therapy*
Venous Thrombosis / etiology,  prevention & control,  therapy*
Chemical
Reg. No./Substance:
0/Anticoagulants
Comments/Corrections
Comment In:
Am Fam Physician. 2005 Jul 1;72(1):36, 41   [PMID:  16035681 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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