Elevation and compression are important—and too often forgotten

Deep vein thrombosis has never been managed well. Before the use of anticoagulants it carried a substantial mortality, rising to over 50% for pulmonary embolism.1 Doctors were slow to adopt anticoagulation before a small randomised trial showed dramatic reductions in mortality and recurrence.2 Since then, however, anticoagulants have been widely used, but simple physical measures—elevation followed by mobilisation with elastic compression—are too often forgotten.

Our aim should be urgent diagnosis and treatment with the twin objectives of (a)g preventing extension of thrombosis, further venous damage, and embolism to the lungs and (b) encouraging clot lysis with restoration of venous function. Studies repeatedly show that clinical diagnosis is unreliable, but this is no excuse for delaying treatment for acute leg swelling associated with calf, popliteal, or femoral vein tenderness. Immediate high elevation and full heparinisation should be started and the diagnosis confirmed urgently. Duplex doppler imaging is ideal, although there is …