Deep vein thrombosis. Diagnosis and management.

In at least 50% of patients with suspected deep vein thrombosis, the diagnosis is not confirmed by objective testing. The addition of impedance plethysmography and real-time B-mode ultrasound with color-enhanced Doppler imaging to the available diagnostic modalities has altered the approach to clinical evaluation. Pharmacologic treatment has evolved to place emphasis on the use of subcutaneous heparins of greater efficacy and the reduction of hemorrhagic risk with the use of the INR system when warfarin is recommended for long-term therapy. Use of new approaches for diagnosis and management offers the potential of more prompt and accurate diagnosis, more effective therapy, and a reduction in the incidence of pulmonary thromboembolism.