10.1177/0897190004271779McGUIREPREVENTION AND TREATMENT OF VTE Therapeutic Update on the Prevention and Treatment of

Venous thromboembolism (VTE) is a common condition that increases in incidence with age and risk factors. Therapies for VTE are aimed at either preventing the disease in high-risk individuals or treating patients who have developed VTE. As-sessing risk and aggressively using the recommended thera-pies is primacy in preventing VTE in surgical and medical patients. Risk of VTE in medical patients has become more defined in recent years, and prophylaxis in this group can prevent scores of iatrogenic VTE. Treatment of VTE has evolved in the past decade from a condition that required hospitalization for 5 to 7 days to a disease state that can be conveniently and safely treated on an outpatient basis, largely due to the advent of low-molecular-weight heparins and patient self-directed treatment. KEY WORDS: Venous thromboembolism, self-directed treatment, low-molecular-weight heparins. VENOUS THROMBOEMBOLISM (VTE) affects ap-proximately 2 million Americans annually and in-cludes the diagnosis of deep vein thrombosis (DVT) and pulmonary embolism (PE).1,2 Data indicate that 280,000 to 300,000 of the 2 million patients who expe-rience VTE are objectively diagnosed with the dis-ease.2,3 VTE is often a silent yet potentially fatal dis-ease. When symptoms do occur, they are often nonspe-cific, and the first manifestation of the disease may be fatal PE.4 Historically, it has been estimated that 60,000 to 100,000 people die each year from PE. However, a more recent estimate of the age-adjusted rate of deaths from PE in the United States concluded that the inci-dence has decreased from 191 per million in 1979 to 94 per million in 1998, a decrease of 56 % for men and 46 % for women.5 Long-term morbidity is also a conse-quence of VTE since unrecognized and untreated thromboembolic episodes predispose patients to re-current events.6,7 DVT is also associated with the devel-opment of postthrombotic syndrome, which is