Deep-vein thrombosis

Deep-vein thrombosis is an important complication of several inherited and acquired disorders, but may also occur spontaneously, prevention of recurre nt venous thrombosis and pulmonary embolism is the main reason for accurate diagnosis and adequate treatment. This seminar discusses only symptomatic deep-vein thrombosis. The diagnosis can be confirmed by objective tests in only about 30% of patients with symptoms. Venous thromboembolic complicatio ns happen in less than 1% of untreated patients in whom the presence of ven ous thrombosis is rejected on the basis of serial ultrasonography or ultras onography plus either D-dimer or clinical score. Initial anticoagulant trea tment (intravenous or subcutaneous heparin) should continue until oral anti coagulant treatment, started concurrently, increases the international norm alised ratio above 2.0 for more than 24 h. The optimum duration of oral ant icoagulant treatment is unresolved, but may be guided by the presence of te mporary or persistent risk factors or presentation with recurrent venous th romboembolism.