Pathogenesis and conservative management of venous thrombosis and pulmonary embolism.

TODAY THROMBOSIS and embolism are the commonest causes of death after a major abdominal operation (Muir, 1968). Since 1960 thrombosis and embolism have been the leading cause of maternal death in England and Wales (Jeffcoate and Tindall, 1965). Morrell, Truelove and Barr (1963) confirmed a marked increase in the decade 1952 to 1961. These findings contrast with the reported incidence in African races (Lee, Davies and Florentin, 1966). Smith, Dexter and Dammin (1965) in post-mortem studies in Boston found pulmonary embolism to be the single most common cause of death. Frieman and his colleagues (1965) also from Boston, found evidence for old or recent pulmonary emboli in 64 per cent of a group of consecutive autopsied patients. Sevitt and Gallagher (1962) also demonstrated a high incidence of venous thrombosis and pulmonary embolism in those dying after injury or burning. During a twelve-month period through 1967-68 twenty patients were seen with venous thrombosis and its complications; a marked increase in the Department of Surgery at the Royal Victoria Hospital (Rogers, 1968). One thousand six hundred and fifty patients were admitted during this period and there were two diagnosed deaths from pulmonary embolus. In three of eight patients with clinical signs of deep venous thrombosis, pulmonary emboli complicated management. Six pulmonary emboli treated were "silent", that is, without signs of peripheral thrombosis (Table I).