Thrombosis Knowledge Centre
Management of Deep Vein Thrombosis
How should a patient with acute DVT be managed?
Accurate diagnosis is mandatory.
Untreated DVT can result in fatal PE, whereas anticoagulation in the absence of thrombosis is not reasonable.
Untreated DVT can result in fatal PE, whereas anticoagulation in the absence of thrombosis is not reasonable.
Treatment of DVT is an emergency.
For patients with a high clinical suspicion of DVT, it is recommended to initiate treatment with anticoagulants as soon as possible while awaiting the outcome of diagnostic tests.
For patients with a high clinical suspicion of DVT, it is recommended to initiate treatment with anticoagulants as soon as possible while awaiting the outcome of diagnostic tests.
Below you will find a list of some rules that apply to the management of patients with DVT.
- Treatment may be performed in hospital or at home
- The aim of anticoagulants is to prevent thrombus extension and recurrence
- Short-acting anticoagulants are used in the initial phase: UFH, LMWH or fondaparinux (Arixtra®)
- Monitoring of aPTT is required with UFH
- Monitoring of plasma anti-Xa activity may be necessary in certain patients treated with LMWH
- Monitoring of platelet count needs to be regularly performed in heparin-treated patients
- Due to their increased safety and convenience, LMWH or fondaparinux (Arixtra®) may be preferred over UFH
- VKA are generally used for long-term treatment
- Once the INR is stabilised, check the INR at least once a month
- Check INR if lifestyle changes or new concomitant medications introduced
- Long-term treatment with LMWH may be used in patients with cancer-related VTE
- The duration of long-term treatment depends on the risks of VTE recurrence and bleeding: it varies from 3 months to life-long
- Since patients at risk for post-thrombotic syndrome cannot be identifi ed in advance, all patients with DVT should be advised to wear below-knee GCS during the first 2 years after the event
Overall management of DVT
Adapted from Kyrle and Eichinger. Lancet 2005;365:1163-74