Venous thromboembolism - diagnosis and therapy

The gynaecologist is regularly confronted with the event of a deep vein thrombosis and - in consequence - with the treat of an acute, potentially fatal pulmonary embolism. The following overview outlines the pathophysiology, diagnostics and therapy of thromboembolism, with particular emphasis on the gynaecological and obstetrical situation. The familiar risks of thrombosis for the patient are multiply increased by temporary risk factors such as surgery, pregnancy or confinement. Given the suspicion of deep vein thrombosis, sonography is increasingly being preferred to venography for diagnostic imaging. Of particular interest is the use of D-dimer testing for the exclusion of pulmonary embolism. Due to the prognostic significance of the disease it is essential to definitely exclude or establish the diagnosis of pulmonary embolism. The essential therapeutic measure involves anticoagulants, thereafter a prophylactic therapy is necessary the length of which is dependent on the clinical picture and the likelihood of relapse.