Management of Deep Vein Thrombosis

Patient Selection for Ambulatory vs Hospital Care

The American College of Chest Physicians recommends treatment at home over hospitalization for patients with acute proximal leg deep vein thrombosis who have adequate home circumstances, access to anticoagulant medications, and the ability to access outpatient follow-up care 1
Patients with deep vein thrombosis who have guaranteed access to anticoagulant medications can be treated ambulatorily 1
Early mobilization is preferred over initial bed rest for patients with deep vein thrombosis 1
The American College of Chest Physicians recommends hospitalization for patients with deep vein thrombosis who have absolute contraindications to anticoagulation, such as active bleeding or severe coagulopathy 1
Patients with pulmonary embolism and hypotension (systolic blood pressure < 90 mm Hg) require hospitalization 2

The American College of Chest Physicians recommends initiating parenteral anticoagulation immediately (with low-molecular-weight heparin, fondaparinux, or unfractionated heparin) in patients with acute deep vein thrombosis who do not have contraindications 1, 2
For patients with acute deep vein thrombosis, direct oral anticoagulants (such as apixaban, dabigatran, edoxaban, or rivaroxaban) are recommended over vitamin K antagonists for the treatment phase 1
The minimum duration of anticoagulation for patients with acute deep vein thrombosis is 3 months without contraindications 1

For patients with deep vein thrombosis associated with cancer, direct oral anticoagulants that inhibit factor Xa (such as apixaban, edoxaban, or rivaroxaban) are preferred over low-molecular-weight heparin 1
Extended anticoagulation without a scheduled stop date is recommended for patients with active cancer and no high risk of bleeding 1
A inferior vena cava filter is indicated as an alternative to anticoagulation for patients with contraindications to anticoagulation 1, 4

Do not delay the initiation of anticoagulation while waiting for diagnostic test results in patients with a high clinical suspicion of deep vein thrombosis 2
Do not use compression stockings alone for post-event deep vein thrombosis prophylaxis; they should be combined with anticoagulation or used with intermittent pneumatic compression devices 3
Do not prolong hospitalization unnecessarily when the patient can be managed safely on an outpatient basis 1
Do not place inferior vena cava filters routinely in addition to anticoagulation; reserve them for absolute contraindications 1, 4