Evolution of therapies in deep vein thrombosis management

Recent years have witnessed significant advances in the prevention and treatment of deep vein thrombosis (DVT). Although anticoagulants have been available for over 60 years, thromboprophylaxis has been widely adopted only over the last decade, mainly in surgical patients. Unfractionated heparin (UFH) and oral anticoagulants are effective as thromboprophylaxis and in the treatment of DVT, but significant drawbacks with both methods, combined with improved understanding of the pathogenesis of thromboembolism, have prompted investigation of novel physical and pharmacological approaches. In particular, the development since 1976 of low-molecular-weight heparins (LMWHs), with their increased convenience and superior benefit:risk ratio, has revolutionized the approach to DVT prophylaxis. However, persistent treatment failure in some patient groups and underlying trends in medical care, such as the increasing move toward outpatient management, are fuelling continuing efforts to develop improved agents. This review provides a brief overview of DVT prophylaxis and treatment, focusing on the historical developments in the use of heparin, and highlighting the likely direction of future progress.