The management of venous thrombosis and pulmonary embolism.

THE purpose of this report is to present the experience of a group which has been intensively studying the management of venous thrombosis and pulmonary embolism during the past two years. The importance of this problem is indicated by the fact that the incidence of fatal embolism occurring as a complication of deep venous thrombosis ranges between 3.4 per cent and 5.7 per cent and that 11 to 18 per cent of patients who survive one pulmonary embolus experience a subsequent embolus which is fata1. 1•2 •3 There has been considerable controversy in recent years as to the superiority of medical or surgical therapy in venous thromboembolism. Present mature judgment now tends towards the cl)nclusion that both surgical and medical management have comparably reduced the fatalities due to initial and subsequent pulmonary emboli. Although admittedly not the complete solution to the problem, either method is undoubtedly preferable to the «do nothing" or "expectant observation" school of management. The institution of anticoagulant therapy or the ligation of the peripheral deep veins are alternative methods, one of which should be employed in practically every patient with deep venous thromboembolism, if that individual is to receive treatment commensutate with present day medical knowledge. A team composed of members of the Departments of Medicine and Surgery Was organized to manage therapy in all cases of venous thrombosis and pulmonary embolism occurring in the Columbia-Presbyterian Medical Center. The cases in this series were drawn from all services of the hospital. Anticoagulant therapy has been the usual method of treatment (in 254 cases) except for the infrequent instances (ten cases) in which anticoagulants were believed to be contraindicated or inappropriate because of a particular clinical situation.