Deep-vein thrombosis treatment

1. bed rest, with elevation of involved leg(s)

2. unless anticoagulation is contraindicated: start heparin aim for APTT = 1.5–2 × control; or fixed-dose of Low-molecular weight heparin, e.g. tinzaparin (Logiparin®, or in the U.S. enoxaparin (Lovenox®). Simultaneously initiate warfarin therapy. Heparin can be stopped after ≈ 5 days.

3. in patients where anticoagulation is contraindicated, consider inferior vena cava interruption or placement of a filter (e.g. Greenfield filter)

4. in non-paralyzed patients, cautiously begin to ambulate after ≈ 7–10 days

5. wear anti-embolic stocking on affected LE indefinitely (limb is always at risk of recurrent DVT).

Treatment is recommended for both proximal and symptomatic distal (isolated calf) DVT. If anticoagulation cannot be administered or is contraindicated for calf DVT, then the recommendations are for serial noninvasive studies over the next 10 to 14 days to assess for proximal progression of the thrombus ¹⁾.