PMID- 10493240
OWN - NLM
STAT- MEDLINE
DCOM- 19991105
LR  - 20051116
IS  - 0957-5235 (Print)
IS  - 0957-5235 (Linking)
VI  - 10 Suppl 2
DP  - 1999 Aug
TI  - Long-term management of deep vein thrombosis.
PG  - S117-22
AB  - A venous thromboembolic event may cause substantial long-term morbidity despite 
      the best available treatment. Venous thromboembolism (VTE) recurs in 
      approximately 30% of patients within eight years of the acute event, and a 
      similar proportion develop post-thrombotic syndrome, imposing a notable clinical 
      and financial burden. Conventional treatment of VTE comprises an initial 5-10 day 
      course of intravenous unfractionated heparin (UFH), followed by oral 
      anticoagulants for 3-6 months. Thrombolytic therapy, vena caval filters and 
      surgical thrombectomy are reserved for patients with complications. Alternative 
      approaches, including more intensive initial anticoagulation or extended 
      secondary prevention, may improve long-term outcomes. Low-molecular-weight 
      heparins (LMWHs) are at least as effective as UFH in acute therapy and are 
      suitable for home treatment, offering the potential for cost reductions and 
      improved patient convenience. Consequently, LMWHs are replacing UFH in initial 
      treatment of VTE. The optimal duration of secondary VTE prophylaxis remains 
      uncertain. Extended therapy with LMWH reduces the frequency of VTE recurrence, 
      but routine use of prolonged therapy is not economically viable. Targeting 
      extended therapy to patients at greatest risk of recurrence, for example, 
      patients with identified congenital thrombophilia, would maximize 
      cost-effectiveness. Comprehensive risk assessment models are now needed to 
      stratify patients for primary VTE risk level, allowing appropriate targeting of 
      prophylaxis, more intensive initial treatment or extended therapy for acute VTE.
FAU - Piovella, F
AU  - Piovella F
AD  - Thrombosis Unit and Angiohaematology Laboratory, IRCCS Policlinico San Matteo, 
      Pavia, Italy. fpiovella@mbox.medit.it
FAU - Barone, M
AU  - Barone M
LA  - eng
PT  - Journal Article
PT  - Review
PL  - England
TA  - Blood Coagul Fibrinolysis
JT  - Blood coagulation & fibrinolysis : an international journal in haemostasis and 
      thrombosis
JID - 9102551
SB  - IM
MH  - Cost-Benefit Analysis
MH  - Disease Management
MH  - Humans
MH  - Time Factors
MH  - Venous Thrombosis/economics/*therapy
RF  - 43
EDAT- 1999/09/24 00:00
MHDA- 1999/09/24 00:01
CRDT- 1999/09/24 00:00
PHST- 1999/09/24 00:00 [pubmed]
PHST- 1999/09/24 00:01 [medline]
PHST- 1999/09/24 00:00 [entrez]
PST - ppublish
SO  - Blood Coagul Fibrinolysis. 1999 Aug;10 Suppl 2:S117-22.