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Last Updated: 10/22/2014  

Deep Venous Thrombosis

  • Use LMWH, fondaparinux, or low-dose subcutaneous unfractionated heparin (in patients with renal insufficiency) for primary prophylaxis for DVT in high-risk medical patients and surgical patients not at highest risk for VTE.

  • Use warfarin or LMWH for primary prophylaxis for DVT in patients having hip or knee replacement, neurosurgery, or major abdominal or pelvic surgery, and patients over age 40 having general surgery for malignancy.

  • In patients undergoing hip or knee replacements, consider oral rivaroxaban as an alternative for primary prophylaxis.

  • Use mechanical compression with graduated compression stockings for primary prophylaxis against postoperative DVT.

  • Categorize patients as high-, intermediate-, or low-risk, according to the Wells clinical score.

  • Perform D-dimer testing to exclude DVT in patients with a low clinical risk score.

  • Select venous ultrasonography in patients with an intermediate or high clinical risk score or a positive D-dimer result.

  • Use LMWH as a first-line therapy for DVT in hospitalized patients and outpatients.

  • Use long-term warfarin in patients with acute VTE, beginning on the day parenteral therapy is initiated.

  • Treat patients with DVT with warfarin for at least 3 to 6 months; consider longer treatment in patients with idiopathic DVT.

  • Recommend graduated compression stockings to patients with DVT to reduce risk for postthrombotic syndrome.

  • Use LMWH for secondary prevention of VTE in patients with underlying cancer.

DOI: 10.7326/d202
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Author(s) and Disclosures:
Emile R. Mohler, III, MD, FACP receives consultancy fees/honoraria from Takeda, Merck, GSK, and Boehringer Ingelheim; has a pending grant from NHLBI for an infrared device to simultaneously measure skeletal blood, muscle blood flow, and oxygenation in patients with PAD; has a current NHLBI grant on microcirculation in claudication and exercise rehabilitation; owns/co-founded Flox Medical; and holds a patent on VOIS device. Steve Goodacre, MD has nothing to disclose.

One or more of the present or past ACP Smart Medicine physician editors worked on this module and had nothing to disclose: Davoren Chick, MD, FACP; Deborah Korenstein, MD, FACP; Marjorie Lazoff, MD, FACP; Richard Lynn, MD, FACP.

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