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

Russell D Hull, MBBS, MSc
Section Editors
Lawrence LK Leung, MD
Jess Mandel, MD
Deputy Editor
Geraldine Finlay, MD


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 "Venous thromboembolism: Initiation of anticoagulation (first 10 days)" and "Venous thromboembolism: Anticoagulation after initial management" and "Rationale and indications for indefinite anticoagulation in patients with venous thromboembolism" and "Treatment, prognosis, and follow-up of acute pulmonary embolism in adults" and "Clinical presentation and diagnosis of the nonpregnant adult with suspected deep vein thrombosis of the lower extremity" and "Prevention of venous thromboembolic disease in acutely ill hospitalized medical adults" and "Prevention of venous thromboembolic disease in surgical patients".)


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

The term unprovoked deep vein thrombosis (DVT) implies that no identifiable provoking environmental event for DVT is evident [1]. In contrast, a provoked DVT is one that is usually caused by a known event (eg, surgery, hospital admission). VTE events can be provoked by transient major risk factors (ie, major surgery >30 minutes, hospitalization or immobility ≥3 days, Cesarean section), transient minor risk factors (minor surgery <30 minutes, hospitalization <3 days, pregnancy, estrogen therapy, reduced mobility ≥3 days) or persistent risk factors. Persistent risk factors include reversible conditions (eg, curable malignancy, inflammatory bowel disease that resolves) 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: Nov 2017. | This topic last updated: Oct 06, 2017.
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