Treatment of venous thromboembolism

There have been some important advances in the treatment of venous thromboembolism during the past 18 months. A randomized trial has confirmed earlier observations indicating an adequate initial heparin effect is required to prevent recurrent venous thromboembolism, and it is critical to achieve this effect within the first 24 hours of therapy. The need to use a validated protocol for administering intravenous heparin is now firmly established. The clinician has a choice between two protocols that have been validated by randomized trials and provide both effective and safe heparin therapy. For patients with clinically suspected pulmonary embolism, the clinician now has a practical noninvasive strategy that avoids pulmonary angiography, identifies patients with proximal-vein thrombosis who require treatment, and avoids the need for treatment and further investigation in the majority of patients.