Treatment of Venous Thromboembolism (VTE)

Deep venous thrombosis (DVT) as a medical problem was first recognized in the 1800s. There are an estimated 250,000 cases of venous thromboembolism (DVT and/or pulmonary embolus) every year in the United States.

The three main underlying causes of DVT: vein wall injury, slow venous blood flow, and hypercoagulability, were established by Virchow in 1859. Other risk factors include hospitalization (with or without surgery), trauma, malignancy, immobilization (including prolonged travel) and prior DVT.

With appropriate treatment, up to two thirds of the clot in a DVT will be reabsorbed within 3 months. More than half of patients will have complete resolution by 9 months, but this process can continue for months to years. Diagnosis is made primarily by duplex ultrasound. The main stay of treatment is therapeutic anticoagulation for at least 3 months, depending on the etiology of the thrombus and associated risk factors.

In certain cases, thrombolysis or thrombectomy may be indicated. Placement of an inferior vena cava filter may also be a consideration. The chronic venous insufficiency that often develops after DVT is also called postphlebitic syndrome and can usually be treated nonoperatively. An elastic plaster dressing with a glycerin - gelatin mixture, known as an Unna boot and still a reliable treatment today, was first described in 1854. Compression stockings and other adjunctive devices are also useful.