Behandlung der tiefen Beinvenenthrombose

A number of aspects regarding the treatment of deep vein thrombosis have changed during recent years. Any treatment approach, however, is still based on a fast and effective anticoagulation. Due to a comparable efficacy and safety profile, LMWH have largely replaced unfractionated heparins during the initial (parenteral) phase of the anticoagulation. In addition, hospitalization and immobilization are no longer regarded mandatory and may be replaced by out-patient care, at least in patients who are not at high risk or would require hospitalization for other reasons. The duration of the anticoagulation depends on the risk/benefit ratio regarding effectivity of treatment, the avoidance of thromboembolic recurrences, and the risk of major bleeding complications. Recent data indicate that an anticoagulation of 3 to 6 months is not always required and that a shorter treatment may be sufficient in defined subsets of patients. Questions under discussion and topics being presently examined in large scale clinical trials include the intensity of anticoagulation, ie the INR range required (2.0 to 3.0 versus 1.5 to 2.0), and the issue whether the long-term application of LMWH may have advantages over the prescription of dicoumarole derivatives, at least in subgroups of patients with venous thromboembolism.