Management

Goals of treatment:

• prevent pulmonary embolus, propagation of clot and recurrence of the DVT
  • around 50% of untreated DVT patients are at risk of developing a symptomatic pulmonary embolism
• prevent severe post-thrombotic syndrome
  • most frequent chronic DVT complication
  • occurs in 30–50% of patients within 2 years after proximal DVT (1)
• prevent loss of limbs due to venous gangrene
• alleviate symptoms

The main measure to achieve these goals is to prevent extension of the thrombus with pharmacological and/or mechanical approaches

Notes:

• provoked DVT or PE in a patient with an antecedent (within 3 months) and transient major clinical risk factor for venous thromboembolism (VTE)
  • for example surgery, trauma, significant immobility (bedbound, unable to walk unaided or likely to spend a substantial proportion of the day in bed or in a chair), pregnancy or puerperium

or in a patient who is having hormonal therapy (oral contraceptive or hormone replacement therapy)

• unprovoked DVT or PE in a patient with:
  • no antecedent major clinical risk factor for VTE who is not having hormonal therapy (oral contraceptive or hormone replacement therapy) or
  • active cancer, thrombophilia or a family history of VTE, because these are underlying risks that remain constant in the patient (2)
    

Reference:

• (1) Strijkers RH et al. Management of deep vein thrombosis and prevention of post-thrombotic syndrome. BMJ. 2011;343:d5916.
• (2) National Institute for Health and Care Excellence (NICE) 2015. Venous thromboembolic diseases: diagnosis, management and thrombophilia testing