VENOUS THROMBOSIS - LIFTING THE CLOUDS OF MISUNDERSTANDING .1.

Deep venous thrombosis (DVT) is often occult and difficult to recogniz e clinically, The diagnostic approach should begin with color-now (dup lex) ultrasound, noninvasive functional tests such as plethysmography, or both. Because these tests are not 100% sensitive, contrast venogra phy or magnetic resonance imaging may be necessary in a patient with u nexplained symptoms, A baseline ventilation-perfusion scan should be c onsidered for any patient with DVT, because there is a high incidence of clinically inapparent pulmonary embolism. In the absence of contrai ndications, systemic or regional thrombolytic therapy should be consid ered for every patient with acute DVT. Surgical thrombectomy may be in dicated for patients with a large, obstructive proximal thrombus, At a minimum, routine treatment should start with heparin and proceed to o ral warfarin (Coumadin, Panwarfin, Sofarin), which should be continued for 3 months. Recurrent DVT after cessation of therapy warrants lifet ime use of anticoagulants. A filter should be placed in the inferior v ena cava whenever a large, poorly adherent thrombus is identified or w hen there is progression of thrombosis despite an anticoagulant regime n.