Theory and Practice in Acute Venous Thrombosis

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Abstract
The purpose of this review has been to outline the basis for proposing, and the details for implementing, a rational and consistent plan of therapy for the management of acute venous thrombosis. We have interpreted the entity of venous thrombosis as representing a common, frequently systemic disease, clinically manifest by focal intravascular coagulation. Concerning this disease, the specific etiology is unknown, the diagnostic criteria are crude and unsatisfactory, and although the clinical course is usually benign and self limited it may be unpredictably recurrent and fatal. We have also inferred that the difficulties in statistically validating any specific therapeutic measure are, for the present, extremely great, and that this problem will not be significantly lessened until an accurate test for thrombosis is devised. To construct a workable frame of reference for the clinical management of venous thrombosis within the limits of our present knowledge, we have formulated the concept of the temporary thrombotic state. Treatment is based upon the neutralization of hypercoagulability by anticoagulant drugs and upon a reduction of venous stasis by the removal of immobilization and a decrease in the size of the peripheral venous pool by elastic support. Various aspects of this therapeutic approach are described in detail and illustrated by selected case studies.