Deep vein thrombosis treatment approach

Editor(s)-In-Chief: The APEX Trial Investigators, C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2] ; Kashish Goel, M.D.; Assistant Editor(s)-In-Chief: Justine Cadet

Deep vein thrombosis Microchapters
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Treatment Approach

The following algorithm describes the treatment approach to DVT:

^#Administer parenteral anticoagulants as per ACCP guidelines using the recommended doses.

^¶Comorbid conditions may include history of hemorrhagic CVA, recent bleeding episodes, recent surgery or trauma, severe uncontrolled hypertension, renal failure, potential for non-compliance, suspicion of PE or pregnancy.

ACCP 2012 Guidelines: Recommendations for Initial Approach in Patients with Acute DVT of the Leg (DO NOT EDIT)

Grade 1

"1. In patients with acute DVT of the leg treated with vitamin K antagonist (VKA) therapy, we recommend initial treatment with parenteral anticoagulation (low-molecular-weight heparin [LMWH], fondaparinux, IV unfractionated heparin [UFH], or subcutaneous [SC] UFH) over no such initial treatment. (Level of evidence B)"

Grade 2

"1. In patients with a high clinical suspicion of acute VTE, we suggest treatment with parenteral anticoagulants compared with no treatment while awaiting the results of diagnostic tests. (Level of evidence C)"

"2. In patients with an intermediate clinical suspicion of acute VTE, we suggest treatment with parenteral anticoagulants compared with no treatment if the results of diagnostic tests are expected to be delayed for more than 4 h (Level of evidence C)."

"3. In patients with a low clinical suspicion of acute VTE, we suggest not treating with parenteral anticoagulants while awaiting the results of diagnostic tests, provided test results are expected within 24 h (Level of evidence C)."