Consensus document on anticoagulant management of deep vein thrombosis: A review

Abstract

Deep-vein thrombosis (DVT) is encountered commonly in clinical practice. Recently, the European Society of Cardiology released guidelines on the diagnosis and management of venous thromboembolism. In this article, the authors reviewed the important aspects of DVT and advised on the clinical diagnosis and management of the same. Further, assessment of bleeding risk, risk of recurrences of DVT, and management of DVT in special situations is reviewed briefly. This will help physicians effectively diagnose and manage DVT in routine practice. Some of the essential clinical pearls include the following. Clinical risk prediction scores such as modified Wells score and Padua prediction score are effective tools used for screening DVT. Along with D-dimer assessment, venous ultrasound is helpful in confirming the DVT in “likely DVT” patients. Anticoagulation should be offered to all the patients diagnosed with DVT. Newer direct oral anticoagulants (DOACs) should be preferred. Among four commonly used DOACs, dabigatran and edoxaban use should be preceded by parenteral anticoagulants for at least 10 days without any drug overlap, whereas rivaroxaban and apixaban should be used as single-drug approach. Treatment duration should be 3–6 months and extended treatment should be based on the assessment of risk of bleeding and recurrences. Special situations such as DVT in upper extremity and in the elderly should be managed as recommended otherwise. For DVT pregnancy, low-molecular-weight heparin should be the anticoagulant of choice.