A Brief History of Deep Vein Thrombosis Treatment – From Antiquity to the Present

The Era of Prayers, Miracles... and the First Documented Case

Based on clues from the New Testament biblical texts, it seems possible that even Jesus Christ suffered from pulmonary embolism and deep vein thrombosis, although this hypothesis has never been confirmed. The disease was partially described in the writings of the famous Oriental physician Avicenna in the 11th century.

However, the first documented written mention of deep vein thrombosis dates back to 1271. Franciscan friar William of Saint-Pathus describes the case of a 20-year-old Norman cobbler named Raoul, who experienced swelling and tenderness in his right calf, with symptoms subsequently spreading to his thigh. The surgeon of that time recommended the young man to wait, resulting in ulceration of the skin on the limb. He was then advised to pray in the crypt of King Louis IX. After several days of prayers and applying dust from the tomb to the area of the ulcer, a miraculous healing occurred.

The Era of Hypotheses and Vein Ligation

Since the first description of a deep vein thrombosis case, the number of recorded cases in written sources increased rapidly. During the Renaissance, physicians believed that deep vein thrombosis occurred only during pregnancy due to the retention of "bad fluids" in the body, and during the period of breastfeeding due to the retention of milk in the limbs. In the 18th century, breastfeeding was thus considered a prevention measure for deep vein thrombosis. Until then, bloodletting was also a popular treatment (as it was for many other health afflictions).

At the end of the 18th century, English physician John Hunter hypothesized that thrombosis was caused by a blood clot and was the first to perform ligation of a vein proximal to the thrombus to prevent further spread of the thrombosis. Ligation was performed in the femoral, iliac, and inferior vena cava regions until the mid-20th century when it was gradually replaced by the application of a caval filter, thrombectomy, and thrombolysis due to the high mortality associated with the method.

In 1856, Rudolf Virchow described the connection between deep vein thrombosis and fatal cases of pulmonary embolism. Throughout the 19th century, the "fluid" hypothesis of disease origin was abandoned in favor of the irritation of the venous wall by infectious inflammation. Until the 1930s, the most common therapeutic modality for deep vein thrombosis was bed rest, for which various immobilization devices were developed.

The Era of Effective Anticoagulant Drugs

In 1884, John Berry Haycraft isolated the first anticoagulant, hirudin, from leech saliva. However, it was not usable until the development of genetic engineering in 1986. The first commonly used anticoagulant in the treatment of deep vein thrombosis was heparin, discovered in 1916 by medical student McLean. The first indication in modern thrombo-prophylaxis was the use of heparin in 1937 for patients undergoing surgery. In Bauer's comparative historical study, the use of heparin reduced the mortality risk from pulmonary embolism from 18% to 0.4%.

In 1948, warfarin was introduced, initially as an effective rat poison, and its use in humans was considered very dangerous. However, a failed suicide attempt by a sailor in which he absorbed 567 mg of warfarin over 5 days dispelled notions of the drug's presumed toxicity, leading to its commercialization in 1954.

The greatest step toward simplifying anticoagulant therapy was the discovery of low-molecular-weight heparins in the 1980s, which became widely used in common clinical practice within a decade and remain the most commonly used anticoagulant drugs alongside new oral anticoagulants.

Throughout the second half of the 20th century, vein ligation was definitively abandoned in surgical procedures; instead, thrombectomy was performed, followed by thrombolysis, with both methods still used in various modifications to this day.

(holi)

Source: Galanaud J.P., Laroche J.P., Righini M. The history and historical treatments of deep vein thrombosis. J Thromb Haemost 2013; 11 (3): 402–411, doi: 10.1111/jth.12127.