Deep venous thrombosis and pulmonary embolism

This chapter reviews the diagnosis of PE and DVT including different testing modalities. Then different therapies are discussed such as thrombolytics. Anticoagulation is discussed and finally prevention of venous thrombosis. At least 300–600,000 patients per year in the United States suffer a first deep venous thrombosis, with 5–10 per 10,000 population suffering a thrombotic event each year. More than 90 % of pulmonary emboli occur as a complication of thrombosis in the deep venous system of the legs. Therefore, treatment and prevention of deep venous thrombosis will reduce the occurrence of pulmonary embolism. Another key point is that more than 90 % of the deaths from pulmonary embolism occur in the first hour. Thus, management is aimed toward prevention of a repeat embolism and not treatment of the initial embolus. It is estimated that the mortality rate of untreated pulmonary embolism is 30–40 %, and the risk of pulmonary embolism from untreated proximal deep venous thrombosis is 50–80 %.