Management of venous thromboembolism: optimization by clinical trials.

Antithrombotic therapy is mandatory in most patients with venous thrombosis. The results of randomized trials have established the requirement for initial treatment with heparin and have determined the optimal anticoagulant regimen for secondary prophylaxis. Recent studies have demonstrated that low molecular weight heparins, that have improved pharmacologic and pharmacokinetic properties over standard heparin, are effective and safe in the treatment of deep vein thrombosis. Two large randomized clinical trials have shown the feasibility of the outpatient treatment of patients with acute deep vein thrombosis with low molecular weight heparins. Home therapy will result in improved clinical utility of anticoagulant treatment and in cost savings.