Venous thromboembolism in men and women

Venous thromboembolism (VTE) is a frequent illness with an annual incidence of 0.1 to 0.2%. Over the last decades, a multitude of acquired and inherited risk factor of VTE has been identified. From the circumstantial risk factors, advancing age and male sex are the important ones. Male sex is not only a risk factor for a first episode of VTE but also confers a high risk of recurrence. Diagnostic and therapeutic strategies are not different between men and women. Venous thromboembolism is diagnosed by combining clinical assessment, measurement of D-dimer and imaging techniques, including ultrasonography and chest computed tomography. The mainstay of treatment for VTE is low-molecular-weight heparin which is given at a dose of 150–200 anti-factor Xa U/kg once-daily or 100 anti-factor Xa U/kg twice-daily. Thrombolysis confers a high bleeding risk and should be restricted to patients with limb-threatening thrombosis or massive pulmonary embolism. Long-term protection of recurrent VTE is achieved by treatment with vitamin K antagonists. The optimal duration of anticoagulation entails balancing the bleeding risk and the risk of recurrence after withdrawal of anticoagulation.