Download PDF
Semin Respir Crit Care Med 2000; 21(6): 561-574
DOI: 10.1055/s-2000-13192
Copyright © 2000 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Venous Thromboembolism: Past, Present and Future

John G. Weg
  • Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan
Further Information

Publication History

Publication Date:
31 December 2000 (online)

    Permissions and Reprints

ABSTRACT

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 ~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.

KEYWORD

Venous thromboembolism - pulmonary embolism - deep venous thrombosis

REFERENCES

  • 1 Stein P D, Terrin M L, Hales C A. Clinical, laboratory, roentgenographic and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease.  Chest . 1991;  100 598-603
    CrossrefPubMedGoogle Scholar
  • 2 Neuhaus A, Bentz R R, Weg J G. Pulmonary embolism in respiratory failure.  Chest . 1978;  73 460-465
    CrossrefPubMedGoogle Scholar
  • 3 Goldhaber S Z, Hennekens C H, Evans D A. Factors associated with correct antemortem diagnosis of major pulmonary embolism.  Am J Med . 1982;  73 822-826
    CrossrefPubMedGoogle Scholar
  • 4 Stein P D, Henry J W. Prevalence of acute pulmonary embolism among patients in a general hospital at autopsy.  Chest . 1995;  108 978-981
    CrossrefPubMedGoogle Scholar
  • 5 Wagner H N, Sabiston Jr C D, McAfee J G. Diagnosis of massive pulmonary embolism in man by radioisotope scanning.  N Engl J Med . 1964;  271 377-384
    CrossrefPubMedGoogle Scholar
  • 6 Wagner H N, Lopez-Majano V, Langam J K. Radioactive xenon in the differential diagnosis of pulmonary embolism.  Radiology . 1968;  91 1168-1174
    CrossrefPubMedGoogle Scholar
  • 7 Moser K M, Guisan M, Cuomo A. Differentiation of pulmonary vascular from parenchymal diseases by ventilation/perfusion scintiphotography.  Ann Intern Med . 1971;  75 597-605
    PubMedGoogle Scholar
  • 8 Sasahara A A, Stein M, Simon M. Pulmonary angiography in the diagnosis of thromboembolic disease.  N Engl J Med . 1964;  270 1075-1081
    PubMedGoogle Scholar
  • 9 Stein P D, O'Connor J F, Dalen J E. The angiographic diagnosis of acute pulmonary embolism: evaluation of criteria.  Am Heart J . 1967;  73 730-741
    CrossrefPubMedGoogle Scholar
  • 10 Bookstein J J, Silver T M. The angiographic differential diagnosis of acute pulmonary embolism.  Radiology . 1974;  110 25-33
    PubMedGoogle Scholar
  • 11 McNeil B J. A diagnostic strategy using ventilation-perfusion studies in patients suspect for pulmonary embolism.  J Nucl Med . 1976;  17 613-616
    PubMedGoogle Scholar
  • 12 Bell W R, Simon T L. A comparative analysis of pulmonary perfusion scans with pulmonary angiograms.  Am Heart J . 1976;  92 700-706
    PubMedGoogle Scholar
  • 13 The PIOPED Investigators. Value of the ventilation/perfusion scan in acute pulmonary embolism: result of the prospective investigators of pulmonary embolism diagnosis (PIOPED).  JAMA . 1990;  263 2753-2759
    Google Scholar
  • 14 Berberich J, Hirsch S. Die roentgenologische Darstellung der Arterien und Venen im lebenden Menschen.  Klin Wochenschr . 1923;  2 2226-2228
    CrossrefPubMedGoogle Scholar
  • 15 Rabinov K, Paulin S. Roentgen diagnosis of venous thrombosis in the leg.  Arch Surg . 1972;  104 134-144
    PubMedGoogle Scholar
  • 16 Landefeld C S, McGuire E, Cohen A M. Clinical findings associated with acute proximal deep vein thrombosis: a basis for quantifying clinical judgment.  Am J Med . 1990;  92 582
    PubMedGoogle Scholar
  • 17 Nicolaides A N, Meadway J, Irving D. The value of the clinical diagnosis of deep venous thrombosis. In: Nicolaides A ed. Thromboembolism Etiology: Advances in Prevention Management. Baltimore: University Park Press 1975
    Google Scholar
  • 18 Wheeler H B, Anderson Jr A F, Cardullo P A. Suspected deep vein thrombosis: management by impedance plethysmography.  Arch Surg . 1982;  117 1206-1209
    PubMedGoogle Scholar
  • 19 Lensing A WA, Doris C I, McGrath F P. A comparison of compression ultrasound with color Doppler ultrasound for the diagnosis of symptomless postoperative deep vein thrombosis.  Arch Intern Med . 1997;  157 765-768
    CrossrefPubMedGoogle Scholar
  • 20 Murray G DW, Best C H. The use of heparin in thrombosis.  Ann Surg . 1947;  108 163-177
    PubMedGoogle Scholar
  • 21 Bauer G. Thrombosis: early diagnosis and abortive treatment with heparin.  Lancet . 1946;  1 448-454
    PubMedGoogle Scholar
  • 22 Barritt D W, Jordan S C. Anticoagulant drugs in the treatment of pulmonary embolism: a controlled trial.  Lancet . 1960;  1 1309-1312
    PubMedGoogle Scholar
  • 23 Butt H R, Allen E V, Bollman J L. A preparation from spoiled sweet clover [331 methylene-bis-(+hydroxycoumarin)] which prolongs coagulation and prothrombic time of the blood: preliminary report of experimental and clinical studies.  Proc Staff Meet Mayo Clin . 1941;  16 388-395
    PubMedGoogle Scholar
  • 24 Allen E V, Hines Jr A E, Kvale W F. The use of dicumarol as an anticoagulant: experience in 2307 cases.  Ann Intern Med . 1947;  27 371-381
    PubMedGoogle Scholar
  • 25 Sevitt S, Gallagher N G. Prevention of venous thrombosis and pulmonary embolism in injured patients.  Lancet . 1959;  1 981-989
    PubMedGoogle Scholar
  • 26 Hirsch J, Dalen J E, Deykin D. Oral anticoagulants: Mechanism of action, clinical effectiveness, and optimal therapeutic range.  Chest . 1995;  108 231S-246S
    PubMedGoogle Scholar
  • 27 Hyers T M, Agnelli G, Hull R D. Sixth ACCP consensus conference on antithrombotic therapy: antithrombotic therapy for venous thromboembolism disease.  Chest. in press; 
    PubMedGoogle Scholar
  • 28 Girard P, Musset D, Parent F. High prevalence of detectable deep venous thrombosis in patients with acute pulmonary embolism.  Chest . 1999;  116 903-908
    CrossrefPubMedGoogle Scholar
  • 29 van Rossum B A, van Houwelingen C H, Kieft G J. Prevalence of deep vein thrombosis in suspected and proven pulmonary embolism: a meta-analysis.  Br J Radiol . 1998;  71 1260-1265
    PubMedGoogle Scholar
  • 30 Weg J G. Venous thromboembolism in pregnancy.  Semin Respir Crit Care Med . 1998;  19 231-241
    PubMedGoogle Scholar
  • 31 Ferrari E, Chevallier T, Chapelier A. Travel as a risk factor for venous thromboembolic disease: a case-control study.  Chest . 1999;  115 440-444
    CrossrefPubMedGoogle Scholar
  • 32 Koster T, Rosendaal F R, deRonde H. Venous thrombosis due to poor anticoagulant response to activated protein C: Leiden thrombophilia study.  Lancet . 1993;  342 1503-1506
    CrossrefPubMedGoogle Scholar
  • 33 Svenson P J, Dahlback B. Resistance to activated protein C as a basis for venous thrombosis.  N Engl J Med . 1994;  330 517-522
    CrossrefPubMedGoogle Scholar
  • 34 Dahlback B, Hildebrand B. Inherited resistance to activated protein C is corrected by anticoagulant cofactor activity found to be a property of factor V.  Proc Natl Acad Sci USA . 1994;  91 1396-1400
    CrossrefPubMedGoogle Scholar
  • 35 Ridker P M, Miletich J P, Hennekens C H. Ethnic distribution of factor V Leiden in 4047 men and women: implications for venous thromboembolism screening.  JAMA . 1997;  277 1305-1307
    CrossrefPubMedGoogle Scholar
  • 36 Rosendaal F R, Siscovick D S, Schwartz S M. A common prothrombin variant (20210 G to A) increases the risk of myocardial infarction in young women.  Blood . 1994;  90 1747-1750
    PubMedGoogle Scholar
  • 37 Fermo I, D'Angelo S V, Paroni R. Prevalence of moderate hyperhomocystenemia in patients with early onset venous and arterial occlusive disease.  Ann Intern Med . 1995;  123 747-753
    PubMedGoogle Scholar
  • 38 Goddijn-Wessel T A, Wouters M G, Van de Molenef S. A risk factor for placental abruption or infarction.  Eur J Obstet Gynecol Reprod Biol . 1996;  66 23-29
    CrossrefPubMedGoogle Scholar
  • 39 Wouters M G, Boers G H, Blom H J. Hyperhomocystenemia: a risk factor along with unexplained recurrent early pregnancy loss.  Fertil Steril . 1993;  60 820-825
    PubMedGoogle Scholar
  • 40 Kearon C, Crowther M, Hirsh J. Management of patients with hereditary hypercoagulable disorders.  Annu Rev Med . 2000;  51 169-185
    CrossrefPubMedGoogle Scholar
  • 41 Lockshin M D. Antiphospholipid antibody syndrome.  Rheum Dis Clin North Am . 1994;  20 45-59
    PubMedGoogle Scholar
  • 42 Ginsberg K S, Wells P S, Brill-Edwards P. Antiphospholipid antibodies and venous thromboembolism.  Blood . 1995;  86 3685-3691
    CrossrefPubMedGoogle Scholar
  • 43 Petri M. Pathogenesis and the treatment of the antiphospholipid antibody syndrome.  Adv Rheum . 1997;  81 151-177
    PubMedGoogle Scholar
  • 44 Waterstone J J, Summers B A, Hoskins M C. Ovarian hyperstimulation syndrome and deep cerebral venous thrombosis.  Br J Obstet Gynaecol . 1992;  99 439-440
    PubMedGoogle Scholar
  • 45 Fournet N, Surrey E, Kerin J. Internal jugular vein thrombosis after ovulation induction with gonadotropins.  Fertil Steril . 1991;  56 354-356
    PubMedGoogle Scholar
  • 46 Lesser B A, Leeper Jr V K, Stein P D. The diagnosis of acute pulmonary embolism in patients with chronic obstructive pulmonary disease.  Chest . 1992;  102 17-22
    CrossrefPubMedGoogle Scholar
  • 47 Miniati M, Pistolesi M, Marini C. Value of perfusion lung scan in the diagnosis of pulmonary embolism: results of the Prospective Investigative Study of Acute Pulmonary Embolism Diagnosis (PISA-PED).  Am J Respir Crit Care Med . 1996;  154 1387-1393
    PubMedGoogle Scholar
  • 48 Stein P D, Athanasoulis C, Alavi A. Complications and validity of pulmonary angiography in acute pulmonary embolism.  Circulation . 1992;  85 462-468
    PubMedGoogle Scholar
  • 49 Heijboer H, Buller H R, Lensing A W. A comparison of real-time compression ultrasonography with impedance plethysmography for the diagnosis of deep-vein thrombosis in symptomatic outpatients.  N Engl J Med . 1993;  329 1365-1369
    Google Scholar
  • 50 Hull R D, Hirsch J, Carter C J. Diagnostic efficacy of impedance plethysmography for clinically suspected deep vein thrombosis.  Ann Intern Med . 1985;  102 21-28
    PubMedGoogle Scholar
  • 51 Huisman M V, Buller H R, Ten Cate W J. Serial impedance plethysmography for suspected deep venous thrombosis in outpatients: the Amsterdam General Practitioner Study.  N Engl J Med . 1986;  314 823-828
    PubMedGoogle Scholar
  • 52 Tapson V F, Carroll B A, Davidson B L. The diagnostic approach to acute venous thromboembolism. Clinical practice guideline. American Thoracic Society.  Am J Respir Crit Care Med . 1999;  160 1043-1066
    PubMedGoogle Scholar
  • 53 Comerota A J, Katz M L, Hashemi H A. Venous duplex imaging for the diagnosis of acute deep venous thrombosis.  Haemostasis . 1993;  23(Suppl 1) 61-71
    PubMedGoogle Scholar
  • 54 Lensing A W, Prandoni P, Brandjes D. Detection of deep-vein thrombosis by real-time B-mode ultrasonography.  N Engl J Med . 1989;  320 342-345
    Google Scholar
  • 55 Messina L M, Sarpa M S, Smith M A. Clinical significance of routine imaging of iliac and calf veins by color flow duplex scanning in patients suspected of having acute lower extremity deep venous thrombosis.  Surgery . 1993;  114 921-927
    PubMedGoogle Scholar
  • 56 Remy-Jardin M, Remy J, Artaud D. Spiral CT of pulmonary embolism: diagnostic approach, interpretive pitfalls and current indications.  Eur Radiol . 1998;  8 1376-1390
    CrossrefPubMedGoogle Scholar
  • 57 Mullins M D, Becker D M, Hagspiel K D. The role of spiral volumetric computed tomography in the diagnosis of pulmonary embolism.  Arch Intern Med . 2000;  160 293-298
    CrossrefPubMedGoogle Scholar
  • 58 Rathbun S W, Raskob G E, Whisett T L. Sensitivity and specificity of helical computed tomography in the diagnosis of pulmonary embolism: a systematic review.  Ann Intern Med . 2000;  132 227-232
    PubMedGoogle Scholar
  • 59 Oser R F, DA Zuckerman, Gutierrez F R. Anatomic distribution of pulmonary emboli at pulmonary angiography: implications for cross-sectional imaging.  Radiology . 1996;  199 31-35
    PubMedGoogle Scholar
  • 60 Stein P D, Henry J W. Prevalence of acute pulmonary embolism in central and subsegmental pulmonary arteries and relation to probability interpretation of ventilation-perfusion lung scans.  Chest . 1997;  111 1246-1248
    PubMedGoogle Scholar
  • 61 Meaney J F, Weg J G, Chenevert T L. Diagnosis of pulmonary embolism with magnetic resonance angiography.  N Engl J Med . 1997;  336 1422-1427
    CrossrefPubMedGoogle Scholar
  • 62 Gupta A, Frazer C K, Ferguson J M. Acute pulmonary embolism: diagnosis with MR angiography.  Radiology . 1999;  210 353-359
    PubMedGoogle Scholar
  • 63 Sostman H D, Layish D T, Tapson V F. Prospective comparison of helical CT and MR imaging in clinically suspected acute pulmonary embolism.  J Magn Reson Imaging . 1996;  6 275-281
    PubMedGoogle Scholar
  • 64 Kubik-Huch R A, Hebisch G, Huch R. Role of duplex color Doppler ultrasound, computed tomography, and MR angiography in the diagnosis of septic puerperal ovarian vein thrombosis.  Abdom Imaging . 1999;  24 85-91
    CrossrefPubMedGoogle Scholar
  • 65 Ginsberg J S, Wells P S, Kearon C. Sensitivity and specificity of a rapid whole-blood assay for D-dimer in the diagnosis of pulmonary embolism.  Ann Intern Med . 1998;  129 1006-1011
    PubMedGoogle Scholar
  • 66 Heit J A, Minor T A, Andrews J C. Determinants of plasma fibrin D-dimer sensitivity for acute pulmonary embolism as defined by pulmonary angiography.  Arch Pathol Lab Med . 1999;  123 235-240
    PubMedGoogle Scholar
  • 67 Oger E, Leroyer C, Bressollette L. Evaluation of a new, rapid, and quantitative D-dimer test in patients with suspected pulmonary embolism.  Am J Respir Crit Care Med . 1998;  158 65-70
    PubMedGoogle Scholar
  • 68 Kollef M H, Zahid M, Eisenberg P R. Predictive value of a rapid semiquantitative D-dimer assay in critically ill patients with suspected venous thromboembolic disease.  Crit Care Med . 2000;  28 414-420
    PubMedGoogle Scholar
  • 69 Farrell S, Hayes T, Shaw M. A negative SimpliREd D-dimer assay result does not exclude the diagnosis of deep vein thrombosis or pulmonary embolus in emergency department patients.  Ann Emerg Med . 2000;  35 121-125
    PubMedGoogle Scholar
  • 70 Francalanci I, Comeglio P, Alessandrello Liotta A. D-dimer plasma levels during normal pregnancy measured by specific ELISA.  Int J Clin Lab Res . 1997;  27 65-67
    PubMedGoogle Scholar
  • 71 Jardin F, Dubourg O, Bourdarias J-P. Echocardiographic pattern of acute cor pulmonale.  Chest . 1997;  111 209-217
    CrossrefPubMedGoogle Scholar
  • 72 Krivee B, Voga G, Zuran I. Diagnosis and treatment of shock due to massive pulmonary embolism.  Chest . 1997;  112 1310-1316
    PubMedGoogle Scholar
  • 73 Viellard-Baron A, Qanadli S D, Antakly Y. Transesophageal echocardiography for the diagnosis of pulmonary embolism with acute cor pulmonale: a comparison with radiological procedures.  Intensive Care Med . 1998;  24 429-433
    CrossrefPubMedGoogle Scholar
  • 74 Pruszczyk P, Torbicki A, Pacho R. Noninvasive diagnosis of suspected severe pulmonary embolism.  Chest . 1997;  112 722-728
    PubMedGoogle Scholar
  • 75 Dolovich L R, Ginsberg J S, Douketis J D. A meta-analysis comparing low-molecular-weight heparins with unfractionated heparin in the treatment of venous thromboembolism: examining some unanswered questions regarding location of treatment, product type, and dosing frequency.  Arch Intern Med . 2000;  160 181-188
    CrossrefPubMedGoogle Scholar
  • 76 A Collaborative European Multicentre Study. A randomized trial of subcutaneous low molecular weight heparin (CY 216) compared with intravenous unfractionated heparin in the treatment of deep vein thrombosis.  Thromb Haemost . 1991;  65 251-256
    PubMedGoogle Scholar
  • 77 Abada J, Nieuwenhuis H K, Sixma J J. Treatment of acute venous thromboembolism with low molecular weight heparin (Fragmin): results of a double-blind randomized study.  Circulation . 1989;  80 935-940
    PubMedGoogle Scholar
  • 78 Bratt G, Aberg W, Johansson M. Two daily subcutaneous injections of Fragmin as compared with intravenous standard heparin in the treatment of deep venous thrombosis (DVT).  Thromb Haemost . 1990;  64 506-510
    PubMedGoogle Scholar
  • 79 Bratt G, Tornebohm E, Granqvist S. A comparison between low molecular weight heparin (KABI 2165) and standard heparin in the intravenous treatment of deep venous thrombosis.  Thromb Haemost . 1985;  54 813-817
    PubMedGoogle Scholar
  • 80 Holm H A, Ly B, Handeland G F. Subcutaneous heparin treatment of deep venous thrombosis: a comparison of unfractionated and low molecular weight heparin.  Haemostasis . 1986;  16 30-37
    PubMedGoogle Scholar
  • 81 Albada J, Neuwenhuis H K, Sixma J J. Comparison of intravenous standard heparin and Fragmin in the treatment of venous thromboembolism: a randomized double-blind study.  Thromb Res . 1987;  7(Suppl) 24
    PubMedGoogle Scholar
  • 82 Simonneau G, Charbonnier B, Decousus H. Subcutaneous low molecular weight heparin compared with continuous intravenous unfractionated heparin in the treatment of proximal deep vein thrombosis.  Arch Intern Med . 1993;  153 1541-1546
    CrossrefPubMedGoogle Scholar
  • 83 Handeland G F, Abildgaard U, Holm H A. Dose adjusted heparin treatment of deep venous thrombosis: a comparison of unfractionated and low molecular weight heparin.  Eur J Clin Pharmacol . 1990;  39 107-112
    CrossrefPubMedGoogle Scholar
  • 84 Prandoni P, Lensing A W, Buller H R. Comparison of subcutaneous low molecular weight heparin with intravenous standard heparin in proximal vein thrombosis.  Lancet . 1992;  339 441-445
    CrossrefPubMedGoogle Scholar
  • 85 Hull R D, Raskob G E, Pineo G F. Subcutaneous low-molecular-weight heparin compared with continuous intravenous unfractionated heparin in the proximal-vein thrombosis.  N Engl J Med . 1992;  326 975-982
    CrossrefPubMedGoogle Scholar
  • 86 Lindmarker P, Holstrom M, Granqvist S. Comparison of once-daily subcutaneous Fragmin with continuous intravenous unfractionated heparin in the treatment of deep vein thrombosis.  Thromb Haemost . 1994;  72 186-190
    PubMedGoogle Scholar
  • 87 Luomanmaki K, Granqvist S, Hallert C. A multicentre comparison of once-daily subcutaneous dalteparin (low molecular weight heparin) and continuous intravenous heparin in the treatment of deep vein thrombosis.  J Intern Med . 1996;  240 85-92
    CrossrefPubMedGoogle Scholar
  • 88 Kirrchmaier C M, Wolf H, Scheafer H. Efficacy of a low molecular weight heparin administered intravenously or subcutaneously in comparison with intravenous unfractionated heparin in the treatment of deep venous thrombosis. Certopain Study Group.  Int Angiol . 1998;  17 135-145
    PubMedGoogle Scholar
  • 89 Meyer G, Brenot F, Pacouret G. Subcutaneous low-molecular-weight heparin fragmin versus intravenous unfractionated heparin in the treatment of acute non massive pulmonary embolism: an open randomized pilot study.  Thromb Haemost . 1995;  74 1432-1435
    PubMedGoogle Scholar
  • 90 Siragusa S, Cosmi B, Piovella F. Low-molecular-weight heparins and unfractionated heparin in the treatment of patients with acute venous thromboembolism: results of a meta-analysis.  Am J Med . 1996;  100 269-277
    CrossrefPubMedGoogle Scholar
  • 91 Gould M K, Dembitzer A D, Doyle R L. Low-molecular-weight heparins compared with unfractionated heparin for treatment of acute deep venous thrombosis.  Ann Intern Med . 1999;  130 800-809
    CrossrefPubMedGoogle Scholar
  • 92 Hull R D, Raskob G E, Brant R F. Low molecular weight heparin vs heparin in the treatment of patients with pulmonary embolism. American-Canadian Thrombosis Study Group.  Arch Intern Med . 2000;  160 229-236
    CrossrefPubMedGoogle Scholar
  • 93 Brandjes D P, Buller H R, Heijboer H. Randomized trial of effect of compression stockings in patients with symptomatic proximal-vein thrombosis.  Lancet . 1997;  349 759-762
    CrossrefPubMedGoogle Scholar
  • 94 Carson J L, Kelley M A, Duff A. The clinical course of pulmonary embolism.  N Engl J Med . 1992;  326 1240-1245
    CrossrefPubMedGoogle Scholar
  • 95 Douketis J D, Kearon C, Bates S. Risk of fatal pulmonary embolism in patients with treated venous thromboembolism.  JAMA . 1998;  279 458-462
    CrossrefPubMedGoogle Scholar
  • 96 Hyers T M. Venous thromboembolism.  Am J Respir Crit Care Med . 1999;  159 1-14
    PubMedGoogle Scholar
  • 97 Casele H L, Laifer S A, Woelkers D A. Changes in the pharmacokinetics of the low-molecular-weight heparin enoxaparin sodium during pregnancy.  Am J Obstet Gynecol . 1999;  181 1113-1117
    CrossrefPubMedGoogle Scholar
  • 98 Levine M, Gent M, Hirsh J. A comparison of low-molecular-weight heparin administered primarily at home with unfractionated heparin administered in the hospital for proximal deep-vein thrombosis.  N Engl J Med . 1996;  334 677-681
    CrossrefPubMedGoogle Scholar
  • 99 Koopman M M, Prandoni P, Piovella F. Treatment of venous thrombosis with intravenous unfractionated heparin administered in the hospital as compared with subcutaneous low-molecular-weight heparin administered at home. The Tasman Study Group.  N Engl J Med . 1996;  334 682-687
    CrossrefPubMedGoogle Scholar
  • 100 Kovacs M J, Anderson D, Morrow B. Outpatient treatment of pulmonary embolism with dalteparin.  Thromb Haemost . 2000;  83 209-211
    PubMedGoogle Scholar
  • 101 Dunn A S, Coller B. Outpatient treatment of deep vein thrombosis: Translating clinical trials into practice.  Am J Med . 1999;  106 660-669
    CrossrefPubMedGoogle Scholar
  • 102 Penner J A. Experience with a thrombin clotting time assay for measuring heparin activity.  Am J Clin Pathol . 1974;  61 645-653
    PubMedGoogle Scholar
  • 103 Baker B A, Adelman M D, Smith P A. Inability of the activated partial thromboplastin time to predict heparin levels. Time to reassess guidelines for heparin assays.  Arch Intern Med . 1997;  157 2475-2479
    CrossrefPubMedGoogle Scholar
  • 104 Krulder J WM, de Boer A, van den Besselaar A H P M. Diurnal rhythm in anticoagulant effect of heparin during low dose constant rate infusion.  Thromb Haemost . 1998;  68 30-32
    PubMedGoogle Scholar
  • 105 Kearon C, Johnston M, Moffat K. Effect of warfarin on activated partial thromboplastin time in patients receiving heparin.  Arch Intern Med . 1998;  158 1140-1143
    CrossrefPubMedGoogle Scholar
  • 106 Delorme M A, Inwood M J, O'Keefe B. Sensitivity of the thrombin clotting time and activated partial thromboplastin time to low level of antithrombin III during heparin therapy.  Clin Lab Haemat . 1990;  12 433-436
    PubMedGoogle Scholar
  • 107 Hull R D, Raskob G E, Rosenbloom D. Optimal therapeutic level of heparin therapy in patients with venous thrombosis.  Arch Intern Med . 1992;  152 1589-1595
    CrossrefPubMedGoogle Scholar
  • 108 Hull R D, Raskob G E, Hirsh J. Continuous intravenous heparin compared with intermittent subcutaneous heparin in the initial treatment of proximal-vein thrombosis.  N Engl J Med . 1986;  315 1109-1114
    CrossrefPubMedGoogle Scholar
  • 109 Hull R D, Raskob G E, Brant R F. Relation between the time to achieve the lower limit of the APTT therapeutic range and recurrent venous thromboembolism during heparin treatment for deep vein thrombosis.  Arch Intern Med . 1997;  157 2562-2568
    CrossrefPubMedGoogle Scholar
  • 110 Hull R, Hirsh J, Jay R. Different intensities of oral anticoagulant therapy in the treatment of proximal-vein thrombosis.  N Engl J Med . 1982;  307 1676-1681
    PubMedGoogle Scholar
  • 111 Schulman S, Granqvist S, Holmstrom M. The duration of oral anticoagulant therapy after a second episode of venous thromboembolism. The Duration of Anticoagulation Trial Study Group.  N Engl J Med . 1997;  336 393-398
    CrossrefPubMedGoogle Scholar
  • 112 Research Committee of the British Thoracic Society. Optimum duration of anticoagulation for deep vein thrombosis and pulmonary embolism.  Lancet . 1992;  340 873-876
    PubMedGoogle Scholar
  • 113 Kearon C, Gent M, Hirsh J. A comparison of three months of anticoagulation with extended anticoagulation for a first episode of idiopathic venous thromboembolism.  N Engl J Med . 1999;  340 901-907
    PubMedGoogle Scholar
  • 114 Schulman S, AS Rhedin, P Lindmarker, et al. A comparison of six weeks with six months of oral anticoagulant therapy after a first episode of venous thromboembolism. Duration of Anticoagulation Trial Study Group.  N Engl J Med . 1995;  332 1661-1665
    CrossrefPubMedGoogle Scholar
  • 115 Toglia M R, Weg J G. Venous thromboembolism during pregnancy.  N Engl J Med . 1996;  335 108-114
    CrossrefPubMedGoogle Scholar
  • 116 Eriksson B I, Wille-Jorgensen P, Kalebo P. A comparison of recombinant hirudin with a low-molecular-weight heparin to prevent thromboembolic complications after total hip replacement.  N Engl J Med . 1997;  337 1329-1335
    CrossrefPubMedGoogle Scholar
  • 117 Schiele F, Vuillemenot A, Kramarz P. Use of recombinant hirudin as antithrombotic treatment in patients with heparin-induced thrombocytopenia.  Am J Hematol . 1995;  50 20-25
    PubMedGoogle Scholar
  • 118 Greinacher A, Volpel H, Janssens U. Recombinant hirudin (lepirudin) provides safe and effective anticoagulation in patients with heparin-induced thrombocytopenia: a prospective study.  Circulation . 1999;  99 73-80
    CrossrefPubMedGoogle Scholar
  • 119 Lewis B E, Walenga J M, Wallis D E. Anticoagulation with Novastan (argatroban) in patients with heparin-induced thrombocytopenia and thrombosis syndrome.  Semin Thromb Hemost . 1997;  23 197-202
    PubMedGoogle Scholar
  • 120 Urokinase Pulmonary Embolism Trial. Phase I results.  JAMA . 1970;  214 2163-2172
    CrossrefPubMedGoogle Scholar
  • 121 Urokinase Streptokinase Pulmonary Embolism Trial. Phase II results.  JAMA . 1974;  229 1606-1613
    CrossrefPubMedGoogle Scholar
  • 122 Levine M, Hirsch J, Weitz J I. A randomized trial of a single bolus dosage regimen of recombinant tissue plasminogen activator in patients with acute pulmonary embolism.  Chest . 1990;  98 1473-1479
    CrossrefPubMedGoogle Scholar
  • 123 Dalla-Volta S, Palla A, Santolicandro A. PAIMS 2: alteplase combined with heparin versus heparin in the treatment of acute pulmonary embolism. Plasminogen activator Italian multicenter study 2.  J Am College Cardiol . 1992;  20 520-526
    CrossrefPubMedGoogle Scholar
  • 124 Dalen J E, Alpert J S, Hirsh J. Thrombolytic therapy for pulmonary embolism: is it effective?.  <~>Is it safe? <~>When is it indicated? Arch Intern Med . 1997;  157 2550-2556
    PubMedGoogle Scholar
  • 125 Mikkola K M, Patel S R, Parker J A. Increasing age is a major risk factor for hemorrhagic complications after pulmonary embolism thrombolysis.  Am Heart J . 1997;  134 69-72
    CrossrefPubMedGoogle Scholar
  • 126 Hyers T M, Hull R D, Weg J G. Antithrombotic therapy for venous thromboembolic disease.  Chest . 1992;  102 408S-425S
    PubMedGoogle Scholar
  • 127 ACCP Consensus Committee on Pulmonary Embolism. Opinions regarding the diagnosis and management of venous thromboembolic disease.  Chest . 1996;  109 233-237
    PubMedGoogle Scholar
  • 128 Konstantinides S, Geibel A, Olschewshi M. Association between thrombolytic treatment and the prognosis of hemodynamically stable patients with major pulmonary embolism. Results of a multicenter registry.  Circulation . 1997;  96 882-888
    CrossrefPubMedGoogle Scholar
  • 129 Kasper W, Konstantinides S, Geibel A. Prognostic significance of right ventricular afterload stress detected by echocardiography in patients with clinically suspected pulmonary embolism.  Heart . 1997;  77 346-349
    PubMedGoogle Scholar
  • 130 Goldhaber S Z, Visani L, DeRosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER).  Lancet . 1999;  353 1386-1389
    CrossrefPubMedGoogle Scholar
  • 131 Ribeiro A, Lindmarker P, Juhlin-Dannfelt A. Echocardiography Doppler in pulmonary embolism: right ventricular dysfunction as a predictor of mortality rate.  Am Heart J . 1997;  134 479-487
    CrossrefPubMedGoogle Scholar
  • 132 Greenfield L J, Rutherford R B. Recommended reporting standards for vena caval filter placement and patient follow-up. Vena Caval Filter Consensus Conference.  J Vasc Intervent Radiol . 1999;  10 1013-1019
    PubMedGoogle Scholar
  • 133 Fink J A, Jones B T. The Greenfield filter as the primary means of therapy in venous thromboembolic disease.  Surg Gynecol Obstet . 1991;  172 253-292
    PubMedGoogle Scholar
  • 134 Leach T A, Pastena J A, Swan K G. Surgical prophylaxis for pulmonary embolism.  Am Surg . 1994;  60 292-295
    PubMedGoogle Scholar
  • 135 Dorfman G S. Percutaneous inferior vena caval filters.  Radiology . 1990;  174 987-992
    PubMedGoogle Scholar
  • 136 Greenfield L J, Proctor M C. Suprarenal filter placement.  J Vasc Surg . 1998;  28 432-438
    PubMedGoogle Scholar
  • 137 Tola J C, Holtzman R, Lottenberg L. Bedside placement of inferior vena cava filters in the intensive care unit.  Am Surg . 1999;  65 833-837
    PubMedGoogle Scholar
  • 138 Linsenmaier U, Rieger J, Schenk F. Indications, management, and complications of temporary inferior vena cava filters.  Cardiovasc Intervent Radiol . 1998;  21 464-469
    CrossrefPubMedGoogle Scholar
  • 139 Spence L K, Gironta M G, Malde H M. Acute upper extremity deep venous thrombosis: Safety and effectiveness of superior vena caval filters.  Radiology . 1999;  210 53-58
    PubMedGoogle Scholar
  • 140 Greenfield L J, Cho K J, Proctor M C. Results of a multicenter study of the modified hook-titanium Greenfield filter.  J Vasc Surg . 1991;  14 253-257
    PubMedGoogle Scholar
  • 141 Decousus H, Leizorovicz A, Parent F. A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. Prevention du Risque d'Embolie Pulmonaire par Interruption Cave Study Group.  N Engl J Med . 1998;  338 409-415
    CrossrefPubMedGoogle Scholar
  • 142 Hubbard K P, Roehm Jr O J, Abbruzzese J L. The bird's nest filter: an alternative to long-term oral anticoagulation in patients with advanced malignancies.  Am J Clin Oncol . 1994;  17 115-117
    PubMedGoogle Scholar
  • 143 Lord R S, Benn I. Early and late results after bird's nest filter placement in the inferior vena cava: clinical and duplex ultrasound follow up.  Aust N Z J Surg . 1994;  64 106-114
    PubMedGoogle Scholar
  • 144 Murphy T P, Dorfman G S, Yedicka J W. LGM vena cava filter: objective evaluation of early results.  J Vasc Intervent Radiol . 1991;  2 107-115
    PubMedGoogle Scholar
  • 145 Millward S F, Peterson R A, Moher D. LGM (Vena Tech) vena caval filter: experience at a single institution.  J Vasc Intervent Radiol . 1994;  5 351-356
    PubMedGoogle Scholar
  • 146 Crochet D P, Brunel P, Trogrlic S. Long-term follow-up of vena tech-LGM filter: predictors and frequency of caval occlusion.  J Vasc Intervent Radiol . 1999;  10 137-142
    CrossrefPubMedGoogle Scholar
  • 147 Bull P G, Mendel H, Schlegl A. Gunther vena caval filters: clinical appraisal.  J Vasc Intervent Radiol . 1992;  34 395-399
    PubMedGoogle Scholar
  • 148 Meyer G, Tamisier D, Sors H. Pulmonary embolectomy: a 20-year experience at one center.  Ann Thorac Surg . 1991;  51 232-236
    PubMedGoogle Scholar
  • 149 Gray H H, Morgan J M, Paneth M. Pulmonary embolectomy for acute massive pulmonary embolism: an analysis of 71 cases.  Br Heart J . 1988;  60 196-200
    CrossrefPubMedGoogle Scholar
  • 150 Clarke D B, Abrams L D. Pulmonary embolectomy: a 25 year experience.  J Thorac Cardiovasc Surg . 1986;  92 442-445
    PubMedGoogle Scholar
  • 151 Ullmann M, Hemmer W, Hannekum A. The urgent pulmonary embolectomy: mechanical resuscitation in the operating theatre determines the outcome.  Thorac Cardiovasc Surg . 1999;  47 5-8
    PubMedGoogle Scholar
  • 152 Stewart J R, Greenfield L J. Transvenous vena caval filtration and pulmonary embolectomy.  Surg Clin North Am . 1982;  62 411-430
    PubMedGoogle Scholar
  • 153 Timsit J F, Reynaud P, Meyer G. Pulmonary embolectomy by catheter device in massive pulmonary embolism.  Chest . 1991;  100 655-658
    PubMedGoogle Scholar
  • 154 Koning R, Cribier A, Gerber L. A new treatment for severe pulmonary embolism: percutaneous rheolytic thrombectomy.  Circulation . 1997;  96 2498-2500
    CrossrefPubMedGoogle Scholar
  • 155 Fava M, Loyola S, Flores P. Mechanical fragmentation and pharmacologic thrombolysis in massive pulmonary embolism.  J Intervent Radiol . 1997;  8 261-266
    PubMedGoogle Scholar
  • 156 Claggett G P, Anderson Jr A F, Geerts W. Prevention of venous thromboembolism.  Chest . 1998;  114 531S-560S
    CrossrefPubMedGoogle Scholar
  • 157 Mismetti P, Laporte-Simitsidis S, Tardy B. Prevention of venous thromboembolism in internal medicine with unfractionated or low-molecular-weight heparins: a meta-analysis of randomised clinical trials.  Thromb Haemost . 2000;  83 14-19
    PubMedGoogle Scholar
  • 158 Hirsch D R, Ingenito E P, Goldhaber S Z. Prevalence of deep venous thrombosis among patients in medical intensive care.  JAMA . 1995;  274 335-337
    CrossrefPubMedGoogle Scholar
  • 159 Pingleton S K, Bone R C, Pingleton W W. Prevention of pulmonary emboli in a respiratory intensive care unit: efficacy of low-dose heparin.  Chest . 1981;  79 647-650
    CrossrefPubMedGoogle Scholar
  • 160 Geerts W H, Jay R M, Code K I. A comparison of low-dose heparin with low-molecular-weight heparin as prophylaxis against venous thromboembolism after major trauma.  N Engl J Med . 1996;  335 701-707
    CrossrefPubMedGoogle Scholar
  • 161 Greenfield L J, Proctor M C, Rodriguez J L. Posttrauma thromboembolism prophylaxis.  J Trauma Injury Infect Crit Care . 1997;  42 100-103
    PubMedGoogle Scholar
  • 162 Knudson M, Morabito D, Paiement G D. Use of low molecular weight heparin in preventing thromboembolism in trauma patients.  J Trauma Injury Infect Crit Care . 1996;  41 446-459
    PubMedGoogle Scholar
  • 163 Hull R, Raskob G, Pineo G. A comparison of subcutaneous low-molecular-weight heparin with warfarin sodium for prophylaxis against deep-vein thrombosis after hip or knee implantation.  N Engl J Med . 1993;  329 1370-1376
    CrossrefPubMedGoogle Scholar
  • 164 Bergqvist D, Benoni G, Bjorgell O. Low-molecular-weight heparin (enoxaparin) as prophylaxis against venous thromboembolism after total hip replacement.  N Engl J Med . 1996;  335 696-700
    CrossrefPubMedGoogle Scholar
  • 165 Modig J, Borg T, Karlstrom G. Thromboembolism after total hip replacement: role of epidural and general anesthesia.  Anesth Analg . 1983;  62 174-180
    PubMedGoogle Scholar
  • 166 McKenzie P J, Wishart H Y, Gray I. Effects of anaesthetic technique on deep vein thrombosis. A comparison of subarachnoid and general anaesthesia.  Br J Anaesth . 1985;  57 853-857
    PubMedGoogle Scholar
  • 167 Collins R, Scrimgeour A, Yusuf S. Reduction in fatal pulmonary embolism and venous thrombosis by perioperative administration of subcutaneous heparin. Overview of results of randomized trials in general, orthopedic, and urologic surgery.  N Engl J Med . 1988;  318 1162-1173
    CrossrefPubMedGoogle Scholar
  • 168 Pulmonary Embolism Prevention (PEP) Trial Collaborative Group. Prevention of pulmonary embolism and deep vein thrombosis with low dose aspirin: pulmonary Embolism Prevention (PEP) trial.  Lancet . 2000;  355 1295-1302
    CrossrefPubMedGoogle Scholar
  • 169 Sors H, Meyer G. Place of aspirin in prophylaxis of venous thromboembolism.  Lancet . 2000;  355 1288-1289
    CrossrefPubMedGoogle Scholar
  • 170 Stratton M A, Anderson F A, Bussey H I. Prevention of venous thromboembolism: adherence to the 1995 American College of Chest Physicians consensus guidelines for surgical patients.  Arch Intern Med . 2000;  160 334-340
    CrossrefPubMedGoogle Scholar
  • 171 Wells P S, Anderson D R, Bormanis J. Value of assessment of pretest probability of deep vein thrombosis in clinical management.  Lancet . 1997;  350 1795-1798
    Google Scholar
  • 172 Wells P S, Ginsberg J S, Anderson D R. Use of clinical model for safe management of patients with suspected pulmonary embolism.  Ann Intern Med . 1998;  129 997-1005
    Google Scholar
  • 173 Miniati M, Prediletto R, Formichi B. Accuracy of clinical assessment in the diagnosis of pulmonary embolism.  Am J Respir Crit Care Med . 1999;  159 864-871
    CrossrefPubMedGoogle Scholar
  • 174 Patil S, Henry J W, Rubenfire M. Neural network in the clinical diagnosis of acute pulmonary embolism.  Chest . 1993;  104 1685-1689
    PubMedGoogle Scholar
  • 175 Tourassi G D, Floyd C E, Coleman R E. Improved noninvasive diagnosis of acute pulmonary embolism with optimally selected clinical and chest radiographic findings.  Acad Radiol . 1996;  3 1012-1018
    PubMedGoogle Scholar

1 *A diligent, but not exhaustive, search was made for the appropriate references in this section.

      >