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Overview of the treatment of lower extremity deep vein thrombosis (DVT)

INTRODUCTION

Deep vein thrombosis (DVT) and acute pulmonary embolism (PE) are two manifestations of venous thromboembolism (VTE). VTE contributes to significant morbidity and mortality both in the community and in hospital. The mainstay of therapy for DVT is anticoagulation, provided there is no contraindication. Following initial anticoagulation, patients with DVT are anticoagulated further to prevent future recurrences, embolism, and thrombosis-related death.

An overview of the treatment of lower extremity DVT (distal and proximal), including indications for anticoagulation, alternate therapies, and treatment of special populations of patients with DVT, are discussed in this topic. Initial, long-term, and extended (indefinite) anticoagulation for DVT, as well as the treatment of PE, upper extremity DVT, and the diagnosis and prevention of DVT are discussed in detail, separately. (See "Deep venous thrombosis: Initiation of anticoagulation (5 to 10 days)" and "Deep venous thrombosis: Long-term anticoagulation (three to six months)" and "Rationale and indications for indefinite anticoagulation in patients with venous thromboembolism" and "Anticoagulation in acute pulmonary embolism" and "Treatment of acute pulmonary embolism" and "Diagnosis of suspected deep vein thrombosis of the lower extremity" and "Prevention of venous thromboembolic disease in medical patients" and "Prevention of venous thromboembolic disease in surgical patients".)

NOMENCLATURE

For the purposes of discussion in this topic, the following terms apply:

The term unprovoked deep venous thrombosis (DVT) implies that no identifiable cause or provoking event for DVT is evident. In contrast, a provoked DVT is one that is usually caused by a known event (eg, surgery, hospital admission). Provoking events and risk factors associated with the development of DVT can be transient (ie, reversible; eg, estrogen therapy) or persistent. Persistent risk factors include reversible conditions (eg, prolonged immobility following surgery, pregnancy, or curable malignancy) and irreversible conditions such as inheritable thrombophilias, chronic heart failure, and metastatic end-stage malignancy. (See "Overview of the causes of venous thrombosis".)

Proximal DVT is one that is located in the popliteal, femoral, or iliac veins. Isolated distal DVT has no proximal component, is located below the knee, and is confined to the calf veins (peroneal, posterior, anterior tibial, and muscular veins) (table 1).

                           

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Literature review current through: Sep 2014. | This topic last updated: Oct 15, 2014.
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