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October 12, 1998

Deep Venous Thrombosis: Thinking Inside Out

Arch Intern Med. 1998;158(18):1964. doi:10.1001/archinte.158.18.1964

VENOUS THROMBOEMBOLIC disease (VTE) is recognized as a significant cause of morbidity and mortality with an incidence of more than 500000 cases per year.1 Patients affected represent many different risk groups in a variety of clinical settings. The diagnosis of deep venous thrombosis (DVT) is at times clinically challenging, with as many as 75% of patients suspected of having VTE lacking objective evidence of thrombosis. Furthermore, up to 50% of patients with thrombosis may be asymptomatic and never receive a diagnosis.2 Heparin has been the mainstay of therapy for documented VTE since the 1960s. Between the 1960s and the 1990s, advances in the treatment of VTE were limited to the transition from bolus to continuous intravenous infusion of heparin and the evolution of dosing nomograms.3 The development of low-molecular-weight (LMW) heparin has led to a reevaluation of the standard treatment of VTE.