Deep Venous Thrombosis and Pulmonary Embolism

N EI’I‘HER the frequency nor the importance of the debilitating and fatal consequences of thromlx~embolic disease has heen fully appreciated t)y must physicians. The following data are presented to stress the high frequent)of this disease. the serious and important nature of its associated sequelae and the difficulties encountered in making the clinical diagnosis. Deep \.enous thrombosis and pulmonar>elnholism are disorders of major significance and are responsible for much long term disahilit!. and an appreciable mortalit>-. If there is to l)c a real reduction in the incidence of pulmonar! eml)olism and the postphlebitic syndrome of edema, induration and ulceration, there must I;c a greater awareness on the part of the clinician of the many and \-aried manifestations of throm t)oembolism. of the value of prompt and cffecti\-c treatment and of procedure< for prcvention. Estrapulation of data obtained at our hospital to mortalit) statistics of the United States suggwt‘: that tlicre ma!. he as man) as 47,000 death5 annuall!in the Cnited States in \vhich pulmonar)cmholism is the sole cause; in addition, there ma). lx three times this man) deaths in which pulmonary cmholim has at least plaxwl a significant role in the outcome. There’are no good mass surveys on the incidence of ulcers of the leg among the population of the LTnited States. Ro)-d et al.’ suggest that in England it is allout fi\-e per thousand population. If this figure can be applied to our population. there may be as man). as 850.000 people in the United States with ulceration of the leg, the majority secondary to postphlebitic change. The incidence of the other manifestations of the postphlet,itic syndrome must Iw considerably higher than this. A number of studies have shown that prompt diagnosis and adequate treatment of deep venous thrombosis can apprecia hly lower the incidence of emtlolic mortality and the significant disability associated xrlth postphlebitic requelae. Particularl>with regard to pulmonary eml)olism, there ih a real need to achiew a much higher diagnostic rate if one hopes to lower significantly the mortality rate from this coinplication. A rc\-iew of the records of laryc autopsy series at our hospital’ has sho\vn that in only 10.6 per cent of patients with prwed pulmonary emboli was a clinical diagnosis of \-enous thromt)osis made prior to death. III another X.6 per cent of these patients localizin!: signs, I\-hlch should have resulted in a diag-nosis of deep venous thromlwsis of the leq, IV& present. The difficulties in diagnosis of this entity are illustrated I)), the fact that in the remainin? patients (80.8 per crnt 1 thcrc were no signs or svmptoms suggesting any tllroml)oric prow+ in tlie \,eins of the leg. despite the fact that a maximum of less than 10 per cent of all ernholi could have arisen from a cardiac source. Tile repeated demonstration of a high failure rate in tllr clinical diagnosis of ti~rorrlI,ueml)olic disease precludes the prescntntion of accurate figures on the incidence of this dixease in a hospital population. Estimates Ixwd on the constant Iwt rather low clinical diagnosis rate as proved at autopsy, plus prior figures obtained in clinically diagnosed cases of throm1xxmtxJism at our hospital, suggest that as man! as 6 per cent of hospitalized patients have deep vu~ous throml)osis, largely undiaqnosrd? during