From the Guidelines
The treatment for Deep Vein Thrombosis (DVT) is anticoagulation therapy, which reduces the risk of DVT extension, recurrent DVT, pulmonary embolism, and post-thrombotic syndrome.
Anticoagulation Options
- For patients with DVT and no cancer, dabigatran, rivaroxaban, apixaban, or edoxaban are suggested over vitamin K antagonist (VKA) therapy, and VKA therapy is suggested over low-molecular-weight heparin (LMWH) 1.
- For patients with DVT and cancer, LMWH is suggested over VKA, dabigatran, rivaroxaban, apixaban, or edoxaban 1.
Treatment Duration
- Anticoagulation may be safely stopped after 3 months in most patients with a first-episode of DVT related to a major reversible risk factor 1.
- Patients with recurrent DVT or unprovoked DVT should be considered for treatment of indefinite duration, with periodic reassessment of risk and benefit 1.
- For most cancer patients with DVT, first-line therapy should be weight-based LMWH monotherapy for at least 3 to 6 months, or as long as the cancer or its treatment is ongoing 1.
Other Considerations
- Inferior vena cava filters are not recommended for patients with DVT treated with anticoagulants 1.
- Compression stockings are not recommended for routine use to prevent post-thrombotic syndrome (PTS) in patients with DVT 1.
- Thrombolytic therapy may be considered for patients with pulmonary embolism and hypotension 1.
From the Research
Treatment Options for Deep Vein Thrombosis (DVT)
- Anticoagulation therapy is the primary treatment for DVT, with the goal of preventing extension of thrombi, pulmonary embolism, recurrence of thrombi, and the development of complications such as pulmonary hypertension and post-thrombotic syndrome 2, 3, 4, 5.
- The treatment can be divided into two main categories:
- Anticoagulant therapy, which includes low-molecular-weight heparin, unfractionated heparin, vitamin K antagonists, and direct oral anticoagulants (DOACs) such as dabigatran, rivaroxaban, and apixaban 2, 3, 4, 5.
- Thrombolytic therapy, which is reserved for massive pulmonary embolism or extensive DVT, and catheter-directed thrombolysis for isolated iliofemoral thrombosis 2, 5.
Duration of Anticoagulant Therapy
- The duration of anticoagulant therapy depends on the individual patient's risk of recurrent venous thromboembolism and the risk of anticoagulant-induced bleeding 2, 5.
- For patients with provoked DVT, 3 months of treatment is usually adequate, while for those with unprovoked or idiopathic DVT, at least 6 months and sometimes indefinite anticoagulant therapy is indicated 2.
- The presence of an antiphospholipid antibody or other selected thrombophilic states may favor more prolonged therapy 2.
Special Considerations
- For patients with distal DVT, anticoagulation therapy with a vitamin K antagonist (VKA) can reduce the risk of recurrent VTE and DVT, but may increase the risk of clinically relevant non-major bleeding events 6.
- The optimal duration of therapy for distal DVT is not clearly established, but anticoagulation for three months or more may be more effective than six weeks of anticoagulation in reducing the incidence of recurrent VTE 6.