Problematic issues surrounding deep vein treatment

Abstract

Deep vein thrombosis (DVT) considered as a severe clinical problem. It caused by the formation of thrombi in deep veins, particularly in the lower limbs. Confirmation of DVT involving the use of Wells score, d-dimers examination and venous compression ultrasound. Anticoagulation proved to decrease mortality rate along with thrombus progression. However, despite major advances, clinician in daily care still poses various issues regarding optimal and best treatment for DVT patients. Anticoagulation (AC) is the backbone for the treatment during all phases of DVT treatment (acute, short term and long term) with the goals is to prevent thrombus progression and DVT complications. Unfractionated heparin (UFH) or low molecular weight heparin (LMWH) commonly used for in-hospitalized patient due to their short duration of action and anticipated antidote availability. Direct oral anticoagulants (DOACs) are also an option for the treatment of DVT patients. DOACs are preferred because they do not require monitoring and more practical in daily care. Furthermore, DVT in obese patients possess unique challenges to clinicians. Difficulty also exist in prescribe treatment for obese patient in term of appropriate dose of LMWH. The same also goes for cancer patients with thrombosis. It should be noted that all cancer-associated thrombosis (CATs) are different therefore, the optimal anticoagulant type, duration, and intensity for the treatment of CAT should probably be individualized. Travel-related DVT has been supported by scientific studies however, more aspects must be understood in order to present more accurate advice for travelers.