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Deep Venous Thrombosis (DVT) – Treatment

Indications for treatment

Treatment modalities (classes of drugs)

  • Anticoagulants
    • Prevent recurrent or ongoing thrombolytic occlusion of the verterobasilar circulation
  • Low molecular weight heparins
    • Prepared by selectively treating UFH to isolate low molecular weight fragments
    • Activity measured in units of factor X inactivation and monitoring of aPTT not required
  • Vitamin K antagonists
    • Class of oral anticoagulant drug that acts as antagonists to vitamin K
    • Interferes with interaction between vitamin K and coagulation factors II, VII, IX, and X
  • Thrombolytics
    • Used to dissolve a pathologic intraluminal thrombus or embolus that has not been dissolved by the endogenous fibrinolytic system
    • Used for prevention of recurrent thrombus formation and rapid restoration of hemodynamic disturbances

Duration of treatment

  • standard recommendations range from 3-6 months
  • in the study by Ridker PM, et al.,: that long-term, low-intensity warfarin therapy is a highly effective method of preventing recurrent VT
    • patients assigned to placebo or low-intensity warfarin (target INR, 1.5 to 2.0) had a risk reduction of 64 percent p < 0.001)
  • in the future, patients with DVT may be tested for thrombophilias (inherited suseptibility), and recommendations for length of treatment are based accordingly
  • patients with DVT need to wear fitted compression stockings for at least two years - will reduce incidence of the post-thrombotic syndrome by 50%
  • in the report by Agnelli G, et al. (2001), the authors sought to determine the optimal duration of treatment
    • patients with a first episode of idiopathic proximal DVT who had completed 3 months of oral anticoagulant therapy were randomly assigned to the discontinuation of oral anticoagulants or to their continuation for 9 additional months
    • analysis showed that of 134 patients assigned to continued oral anticoagulant therapy, 21 had a recurrence of DVT (15.7 %; average follow-up, 37.8 months), as compared with 21 of 133 patients assigned to the discontinuation of oral anticoagulant therapy (15.8 percent; average follow-up, 37.2 months), resulting in a relative risk of 0.99 (95 % CI, 0.57 to 1.73)
    • incidence of recurrence after the discontinuation of treatment was 5.1 % per patient-year in patients in whom oral anticoagulant therapy was discontinued after 3 months and 5.0 percent per patient-year in patients who received an additional 9 months of oral anticoagulant therapy
    • authors concluded that the clinical benefit associated with extending duration of anticoagulant therapy to one year is not maintained after therapy is discontinued
  • references

Use of D-dimer to determine length of treatment

Superficial DVT

Post-thrombotic syndrome

References

Patient-reported treatment satisfaction with oral rivaroxaban versus standard therapy in the treatment of acute symptomatic deep-vein thrombosis.

Oral rivaroxaban for symptomatic venous thromboembolism.

Rivaroxaban (Xarelto) Criteria for Use for Treatment of Venous Thromboembolism (VTE)