Original communication| Volume 46, ISSUE 3, P588-604, September 1959

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Venous thromboembolism

A summary of 10 years' experience with 610 patients and the evolution of a routine management
  • John N. Shadid
    From the Vascular Surgery Section, Washington Hospital Center Washington, D. C., U.S.A.

    From the Department of Vascular Surgery, the Central Dispensary and Emergency Hospital Washington, D. C., U.S.A.
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  • Author Footnotes
    ∗ Attending, Department of Surgery, Washington Hospital Center, Washington, D. C.
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      The most important result of this routine of management has been the clearing of the uncertainties that clouded decisions of diagnosis and treatment in the uneasy situations that can be presented by venous thromboembolism. This was particularly true in the patients only suspected of having venous thrombosis or embolism where the giving or withholding of specific treatment has been made more certain. There were no such fatalities in Group B (Table II) as contrasted with the 3 fatalities in Group A. There was no need to try to differentiate between thrombophlebitis or phlebothrombosis. The selection of the type of treatment and its duration was no longer fettered with doubt in either the suspected or obvious case of venous thromboembolism. Heparin has proved to be a very satisfactory and safe drug which requires very little or no laboratory control and the only anticoagulant necessary in 90 per cent of the patients needing such treatment. The more meticulous attention demanded by Dicumarol was reserved for the 10 per cent that required treatment for more than 2 weeks. Deep venous ligation was narrowed down to the rare patient in whom anticoagulant therapy has honestly failed. Superficial venous thrombosis has been further tagged as a usually benign condition and treatment in most cases need not be directed against the clotting mechanism. It has reduced anticoagulant therapy to 60 per cent of patients with known or suspected venous thromboembolism and this for less than 2 weeks while the remaining 40 per cent received nonspecific treatment for about 1 week. This is in contrast to the 2 to 6 weeks of anticoagulant therapy for venous thromboembolism in general use. This reduction in the period and type of treatment has been associated with a drop in mortality to 0.3 per cent for venous thromboembolism or to 1.0 per cent, if all fatal pulmonary emboli, irrespective of source, are considered. This method, in attempting to estimate the factors involved in thromboembolism, provides a more precise selection of patients for specific therapy which not only safely minimizes the period of disability but also focuses attention on those that need revisions of existing therapy or the finding of new treatments.
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