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January 14, 2008

Venous Thromboembolism and the Archives of Internal Medicine, 1908 to 2005

Arch Intern Med. 2008;168(1):14-15. doi:10.1001/archinternmed.2007.3

As the Archives completes its first 100 years of publication, there is an opportunity to review the topic of venous thromboembolism (VTE) as represented in articles in the Archives. When the Archives began publication in 1908, venous thrombosis and its complication, pulmonary embolism (PE), had been clearly described by Virchow in 1859.1 However, in 1908, the clinical diagnosis was elusive; there were no diagnostic tests to aid its recognition.2 Most cases of VTE were discovered post mortem. The only available therapy was pulmonary embolectomy, which had just been described by Trendelenburg.3 Today, the diagnosis is greatly aided by the availability of chest x-rays (since the 1920s), electrocardiography (since the 1930s), arterial blood gases (since the 1960s), pulmonary angiography (since the 1960s), ventilation-perfusion scans (since the 1960s), computed tomographic scans (since the 1970s), Doppler ultrasonography of the legs, and D-dimer tests (since the 1990s).2 Effective therapy with venous interruption (available since the 1930s), anticoagulants (since the 1940s), and thrombolytic therapy (since the 1960s) is available.3 The mortality of PE, if the diagnosis is made and therapy is initiated, is less than 5%.3