DVT treatment in 2000: state of the art.

In the past, only symptomatic, objectively confirmed, deep vein thrombosis (DVT) was treated with intravenous (or less commonly, twice-daily subcutaneous) unfractionated heparin in the hospital. Now, asymptomatic DVT (especially calf DVT) is also diagnosed by venography in clinical trials of antithrombotic therapies. Magnetic resonance imaging, ultrasound tests, and occasionally venography are identifying symptomatic calf DVT. Upper extremity and superior vena cava DVT are also being diagnosed more frequently, especially in hospitalized patients. For all of these patients, hospitalized or not, subcutaneous low-molecular-weight heparin likely represents the best therapeutic alternative. Twice-daily dosing is probably safest, but evidence supports once-daily dosing with some agents in certain circumstances. Outpatient treatment is proven safe in reliable patients with minimal comorbidities and significant cost-saving implications. The duration of anticoagulant treatment (usually, but not necessarily, oral) for different patient categories is the next area requiring disciplined scientific investigation.