Pathophysiology and Pharmacologic Treatment of Venous Thromboembolism
Jonathan Bain, Douglas R. Oyler, Susan S. Smyth and Tracy E. Macaulay
Affiliation: Division of Cardiovascular Medicine, The Gill Heart Institute, UK HealthCare, 900 South Limestone, Lexington, Kentucky 40536, USA.
Keywords: Venous thrombolism, pulmonary embolism, heparin, warfarin, EKOS, factor Xa inhibitors, direct thrombin inhibitors.
Venous thrombosis is a common medical disorder affecting nearly one million Americans each year. This review
will focus primarily on the formation of venous thrombosis as well as current and future treatment options. While the
full pathophysiology of venous thrombosis is not known, recent evidence points to a role for von Willebrand Factor, platelets,
and neutrophils in thrombus formation. Many laboratory and imaging tests may be used for the diagnosis of venous
thrombosis (VTE), but risk factor identification and clinical examination should not be overlooked as they are vital in assuring
accurate treatment and patient identification. Historically heparin followed by a vitamin K antagonist has been the
standard of care for treatment of VTE, but increasing data involving factor Xa inhibitors and direct thrombin inhibitors
may mean a shift in first-line therapy in the very near future. Invasive therapies such as catheter-directed thrombolysis
have also shown promise in the treatment of venous thrombosis and will likely see increased use in the future.
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