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(Circulation. 2004;110:I-2.)
© 2004 American Heart Association, Inc.

Preface

Management of Venous Thromboembolism: Present and Future

Jeffrey I. Weitz, MD

Professor of Medicine and Biochemistry, McMaster University, Director, Henderson Research Centre, HSFO/J.F. Mustard Chair in Cardiovascular Research, Canada Research Chair (Tier 1) in Thrombosis

An extract of the first 250 words of the full text is provided, because this article has no abstract.

An estimated 2 million people in the United States develop venous thromboembolism (VTE) annually. Anticoagulant therapy is the mainstay of VTE treatment. Once the diagnosis of VTE is established, prompt anticoagulation is necessary to prevent thrombus growth and to reduce the risk of pulmonary embolism (PE). At present, rapid anticoagulation can only be effected with parenteral agents. Low-molecular-weight heparin (LMWH) is rapidly replacing unfractionated heparin as the drug of choice for the initial treatment of most VTE patients. Because it can be given subcutaneously once or twice daily without coagulation monitoring, LMWH allows out-of-hospital management of patients with uncomplicated VTE, an approach that reduces healthcare costs and improves patient satisfaction.

Extended anticoagulant treatment is necessary to prevent recurrent VTE. Vitamin K antagonists are the agents most often used for this purpose, and warfarin is the current drug of choice in North America. Recent clinical trials have provided important information regarding the optimal duration and intensity of anticoagulation treatment for patients with VTE. Anticoagulation therapy must be continued until the benefits of such treatment no longer outweigh the bleeding risk associated with long-term anticoagulation. What we have learned in recent years is that the risk of recurrent VTE after stopping anticoagulant therapy is low in patients whose VTE occurred in the setting of well-recognized reversible risk factors, such as surgery. In contrast, the risk of recurrence is high with ongoing risk factors, such as metastatic cancer.

Surprisingly, the risk of recurrent VTE also is high when anticoagulation therapy is stopped in . . . [Full Text of this Article]