Treatment of DVT
The treatment of DVT is aimed at reducing long-term morbidity, preventing recurrence and reducing risk of embolic disease (i.e. PE). The mainstay of therapeutic intervention is anticoagulation. Specifically, in the UK, this is usually achieved with warfarin (oral vitamin K antagonist) in the long term, using low molecular weight heparin (LMWH) or fondaparinux as bridging therapy until the patient has achieved therapeutic anticoagulation with warfarin. Novel oral anticoagulants (NOACs) are being increasingly used and are now recommended as a viable option by new NICE guidelines for definitive treatment for those with confirmed DVT.
There is uncertainty over the role of anticoagulation for isolated distal (below knee) DVT; current NICE Guidance4 recommends anticoagulation for proximal DVT defined as occurring in the popliteal vein or above.
Medium and long term treatment of DVT is the responsibility of GPs or ward based physicians and careful collaboration is required.