Venous thromboembolism: past, present and future

Over the last four decades there have been remarkable advances in the diagnosis and treatment of venous thromboembolism (VTE)-pulmonary embolism (PE) and deep venous thrombosis (DVT). We have moved from no objective documentation to a plethora of ever improving imaging studies. Evolving treatment modalities have reduced the mortality due to PE to approximately 2%. Shorter hospitalizations followed by outpatient therapy are a growing reality. The use of primary prophylaxis is increasing, but more widespread use must be encouraged. Despite the many accomplishments, too many patients with VTE with its high mortality without treatment remain undiagnosed. There is a critical need to improve the role of the patient's history in identifying patients who warrant objective testing. The ideal would be the development of a biological marker of VTE, similar to the creatinine kinase-MB, creatinine kinase-MM, or troponin I in acute myocardial infarction.