[Medical aspects of thrombosis of the limbs]

Deep vein thrombosis (DVT) of the limbs is a common event that may cause disability or even death. Of the triad of Virchow, which indicates the pathogenic factors involved in DVT, hypercoagulability is very important. The clinical diagnosis of DVT is not reliable and needs objective confirmation before a therapeutic decision can be made. Phlebography is still considered the treatment of choice for DVT diagnosis. Non invasive, less expensive diagnostic procedures have become available: among these, real time B-mode ultrasonography is the most promising. Laboratory tests are essentially non-specific and of little help in DVT diagnosis: they are essential to monitor anticoagulant therapy however, and to screen for congenital disorders that predispose to thrombosis. Therapy of DVT is based on the correct use of heparin and oral anticoagulants: only a few patients should be treated with thrombolytic drugs. Low-dose heparin is considered the most effective treatment for post-surgical DVT prevention and should be more widely used. New low molecular weight heparins have proven to be more efficacious and safe in DVT prophylaxis after orthopedic surgery.