management

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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:

Last edited 04/2020 and last reviewed 05/2020

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