Introduction

Venous thromboembolism (VTE) is one of the most common cardiovascular disorders in the United States. VTE is manifested as deep vein thrombosis (DVT) and pulmonary embolism (PE) resulting from thrombus formation in the venous circulation (Fig. 10-1).1 It is often provoked by prolonged immobility and vascular injury and is most frequently seen in patients who have been hospitalized for a serious medical illness, trauma, or major surgery. VTE can also occur with little or no provocation in patients who have an underlying hypercoagulable disorder.

FIGURE 10-1. Venous circulation. (From Haines ST, Witt DM, Nutescu EA. Venous thromboembolism. In: DiPiro JT, Talbert RL, Yee GC, et al., eds. Pharmacotherapy: A Pathophysiologic Approach, 7th ed. New York: McGraw-Hill; 2008:332.)

While VTE may initially cause few or no symptoms, the first overt manifestation of the disease may be sudden death. Death from PE can occur within minutes, before effective treatment can be given. In addition to the symptoms produced by the acute event, the long-term sequelae of VTE such as the post-thrombotic syndrome (PTS; a complication of VTE occurring due to damage to the vein caused by a blood clot and that leads to development of symptomatic venous insufficiency such as chronic lower extremity swelling, pain, tenderness, skin discoloration, and ulceration) and recurrent thromboembolic events cause long-term pain and suffering.

The treatment of VTE is fraught with substantial risks.3 Antithrombotic drugs require precise dosing and meticulous monitoring, as well as ongoing patient education.4'5 Well-organized anticoagulation management services improve the quality of patient care and reduce the overall cost. A systematic approach to drug therapy management substantially reduces these risks, but bleeding remains a common and serious complication.5 Therefore, preventing VTE is paramount to improving outcomes. When VTE is suspected, a rapid and accurate diagnosis is critical to making appropriate treatment decisions. The optimal use of antithrombotic drugs requires not only an in-depth knowledge of their pharmacology and pharmacokinetic properties, but also a comprehensive approach to patient management.6

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