VENOUS THROMBOSES - A DIAGNOSTIC AND THERAPEUTIC CHALLENGE

Purpose: Venous thrombosis and embolism has been the target of intensi ve investigation in recent years,The growing importance of mortality a nd morbidity due to veno us thromboembolism led to new diagnostic and therapeutic tools. The clinical diagnosis may be misleading and both f alse-negative and false-positive diagnoses are common, when only clini cal signs and symptoms are considered. Methods: A major problem in the care of the patient is to establish the correct diagnosis. Studies sh ow, that on ly Venography or Duplexsonography can clearify diagnosis. Risk factors for venous thromboembolism, propability calculations and consensus recommandations for diagnosis and therapy are presented. Res ults: Diagnosis. Diagnosis of deep vein thrombosis must be established by Duplex-ultrasound and/or venography. Special situations may need f urther investigation by CT-scan or NMR-tomography. No single clinical sign or combination of signs give enough sensitivity and specificity. In patients with thromboembolism without clear etiology, hypercoagulab ility, neoplasms, compression syndroms, vascultides and other conditio ns have to be excluded. Therapy: Heparins are the standard-therapy Low -molecular weight heparins may have some benefits over standard hepari ns in terms of side effects and handling. Coumarin therapy can be star ted immediately, if no invasive procedures are necessary and have to b e continued for 4-12 months, in recurred events and/or hypercoagulabil ity even life-long.Thrombolysis is restricted to very few patients (pa tients under the age of 50 with large thrombosis not older than 3-7 da ys and no contraindications). Surgical thrombectomy is even more restr icted. Compression therapy should be obligatory in all patients with t hromboembolism, Conclusions:Thromboembolism is mainly a diagnostic cha llenge. The immediate start of the appropriate treatment may reduce em bolism and thrombus formation, induce recanalisation and prevent post- thrombotic syndrom.