Mar 21, 2006

Update in the prevention and treatment of deep vein thrombosis and pulmonary embolism

Current Opinion in Anaesthesiology
Johann MotschBernd W Böttiger


Thromboembolic events have a major impact on outcome of surgical and medical patients. This review is focused on standards and recent advances in antithrombotic strategies for prevention and therapy of venous thromboembolism and pulmonary embolism. Alert programs improve prophylactic strategies to prevent venous thromboembolism. Evidenced-based guidelines are available on antithrombotic and thrombolytic therapy outweighing the benefits, risks, burdens and costs. Selective factor Xa and direct thrombin inhibitors are at least as effective as low-molecular-weight heparin in prevention of venous thromboembolism and treatment of pulmonary embolism, but have fewer side effects and will not need routine monitoring. In high-risk orthopaedic patients but not in general surgery patients fondaparinux is superior to low-molecular-weight heparin in the prevention of thromboembolic disease. Ximelagatran, the first oral direct thrombin inhibitor, is as effective and well tolerated as warfarin. Long-term treatment is uncertain, however, because of elevation in alanine transaminase levels. In high-risk patients with contraindication for anticoagulation, retrievable vena cava filters may be an option to prevent pulmonary embolism. Permanent cav...Continue Reading

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Mentioned in this Paper

Entire Vena Cava
Pulmonary Embolism
Deep Vein Thrombosis of Lower Limb
Deep Vein Thrombosis
Venous Thromboembolism
Venous Thrombosis
Negative Regulation of Coagulation

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