Treatment of Deep Vein Thrombosis in Patients with Neurofibromatosis

Initial Management

The American College of Chest Physicians recommends beginning with parenteral anticoagulation while transitioning to oral anticoagulation for patients with deep vein thrombosis (DVT) 3
For acute DVT without contraindications, the American College of Chest Physicians suggests initiating a direct-acting oral anticoagulant (DOAC) over vitamin K antagonist (VKA) therapy 2
If using VKA therapy, the American College of Chest Physicians recommends starting it early and continuing parenteral anticoagulation for at least 5 days and until the INR is ≥2.0 4
Home treatment is recommended for patients with adequate home circumstances, according to the American College of Chest Physicians 1

For provoked DVT, the American College of Chest Physicians recommends treating with anticoagulation for 3 months, regardless of whether the patient has neurofibromatosis 5, 2, 1
For a first unprovoked proximal DVT, the American College of Chest Physicians suggests extended anticoagulation if bleeding risk is low or moderate 6
For a second unprovoked VTE, the American College of Chest Physicians recommends extended anticoagulant therapy for those with low bleeding risk, and suggests extended therapy for those with moderate bleeding risk 7

For patients without cancer, the American College of Chest Physicians suggests DOAC over VKA therapy 2
For patients with cancer, the American College of Chest Physicians suggests low-molecular-weight heparin (LMWH) over VKA, DOAC, or other oral agents 2
If using VKA, the American College of Chest Physicians recommends maintaining a therapeutic INR range of 2.0-3.0 (target INR of 2.5) 7

The American College of Chest Physicians recommends IVC filters only for patients who have contraindications to anticoagulation 1
Routine use of an IVC filter in addition to anticoagulation is not recommended by the American College of Chest Physicians 1
The American College of Chest Physicians suggests anticoagulation alone over interventional therapy for most patients 1
For patients who develop post-thrombotic syndrome (PTS), the American College of Chest Physicians suggests a trial of compression bandages or sleeves to reduce symptoms 1

The American College of Chest Physicians recommends reassessing the need for continued anticoagulation at periodic intervals (e.g., annually) in patients receiving extended therapy 2