page_title: Deep vein thrombosis
section_title: History
hierarchical_section_title: Deep vein thrombosis / Social / History
caption_attribution_description: English: German scientist and politician Rudolf Virchow
context_page_description: Deep vein thrombosis is the formation of a blood clot in a deep vein, most commonly in the legs or pelvis. Symptoms can include pain, swelling, redness, and enlarged veins in the affected area, but some DVTs have no symptoms. The most common life-threatening concern with DVT is the potential for a clot to detach, travel through the right side of the heart, and become stuck in arteries that supply blood to the lungs. This is called pulmonary embolism. Both DVT and PE are considered as part of the same overall disease process, which is called venous thromboembolism. VTE can occur as an isolated DVT or as PE with or without DVT. The most frequent long-term complication is post-thrombotic syndrome, which can cause pain, swelling, a sensation of heaviness, itching, and in severe cases, ulcers. Also, recurrent VTE occurs in about 30% of those in the ten years following an initial VTE.
  The mechanism of clot formation typically involves some combination of decreased blood flow rate, increased tendency to clot, and injury to the blood vessel wall.
context_section_description: The book Sushruta Samhita, an Ayurvedic text published around 600–900 BC, contains what has been cited as the first description of DVT. In 1271, DVT symptoms in the leg of a 20-year-old male were described in a French manuscript, which has been cited as the first case or the first Western reference to DVT. At some point, the increased incidence of DVT in women after childbirth was noticed, and in the late 1700s, a public health recommendation was issued to encourage women to breastfeed as a means to prevent this phenomenon; the DVT was called "milk leg", as it was thought to result from milk building up in the leg.
  In 1856, German physician and pathologist Rudolf Virchow published his analysis after the insertion of foreign bodies into the jugular veins of dogs, which migrated to the pulmonary arteries. These foreign bodies caused pulmonary emboli, and Virchow was focused on explaining their consequences. He cited three factors, which are now understood as hypercoaguability, stasis, and endothelial injury. It was not until 1950 that this framework was cited as Virchow's triad, but the teaching of Virchow's triad has continued in light of its utility as a theoretical framework and as a recognition of the significant progress Virchow made in expanding the understanding of VTE.
  Methods to observe DVT by ultrasound were established in the 1960s. Diagnoses were commonly performed by impedance plethysmography in the 1970s and 1980s, but ultrasound, particularly after utility of probe compression was demonstrated in 1986, became the preferred diagnostic method. Yet, in the mid 1990s, contrast venography and impedance plethysmography were still described as common.
  Multiple pharmacological therapies for DVT were introduced in the 20th century: oral anticoagulants in the 1940s, subcutaneous injections of LDUH in 1962 and subcutaneous injections of LMWH in 1982. For around 50 years, a months-long warfarin (Coumadin) regimen was the mainstay of pharmacological treatment. To avoid the blood monitoring required with warfarin and the injections required by heparin and heparin-like medicines, a new generation of oral anticoagulant pills that do not require blood monitoring has sought to replace these traditional anticoagulants. In the late 2000s to early 2010s, direct oral anticoagulants—including rivaroxaban (Xarelto), apixaban (Eliquis), and dabigatran (Pradaxa)—came to the market, making this field of medicine fast changing. The New York Times described a "furious battle" among the three makers of these drugs "for the prescription pads of doctors".
caption: Rudolf Virchow
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