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(Circulation. 2004;110:I-3 – I-9.)
© 2004 American Heart Association, Inc.

Treatment of Venous Thromboembolism

Initial Treatment of Venous Thromboembolism

Simon J. McRae, MBBS; Jeffrey S. Ginsberg, MD

From the Department of Medicine, McMaster University, Hamilton, Ontario, Canada.

Correspondence to Dr Simon J. McRae, Clinical Fellow, McMaster University Medical Centre HSC 3W11, 1200 Main St West, Hamilton, Ontario, Canada, L8N 3Z5. E-mail smcrae{at}mcmaster.ca

Adequate initial anticoagulant therapy of deep venous thrombosis (DVT) is required to prevent thrombus growth and pulmonary embolism (PE). Intravenous unfractionated heparin (UFH) is being replaced by low-molecular-weight heparin (LMWH) as the anticoagulant of choice for initial treatment of venous thromboembolism (VTE). Both agents are relatively safe and effective when used to treat VTE, with LMWH suitable for outpatient therapy because of improved bioavailability and more predictable anticoagulant response. Serious potential complications of heparin therapy, such as heparin-induced thrombocytopenia (HIT) and osteoporosis, seem less common with LMWH. The potential for fetal harm and changes in maternal physiology complicate the treatment of VTE during pregnancy. Although systemic thrombolysis is used in patients with massive PE and in some patients with proximal DVT, controversy persists with respect to appropriate patient selection for this intervention.

Key Words: venous thromboembolism • pulmonary embolism • deep venous thrombosis • anticoagulants • thrombosis • heparin