Treatment of proximal deep venous thrombosis of the lower extremity

DVT: deep venous thrombosis; IVC: inferior vena cava.

* Manifestations of DVT that are concerning for potential or actual limb-threatening ischemia include sudden severe pain, swelling, cyanosis, edema, venous gangrene, compartment syndrome, and absent pulses. Delay in treatment may result in circulatory collapse, shock, death, or loss of the patient's limb.

¶ Many patients with proximal DVT and high bleeding risk are anticoagulated, though occasionally bleeding risk may be prohibitively high and outweigh benefits of anticoagulation.

Δ Most currently manufactured filters are retrievable. Consideration of filter retrieval is needed to minimize long-term complications (in particular, recurrent DVT).

◊ The minimum duration of anticoagulation is three months; however, select patients may be candidates for indefinite anticoagulant therapy. Choice of anticoagulant is dependent upon several factors including hemodynamic stability, anticipated need for discontinuation, comorbidities, patient preference, cost, and previous history of kidney function impairment and heparin-induced thrombocytopenia. Refer to UoToDate text for details.