Treatment of distal deep venous thrombosis of the lower extremity

This algorithm only applies to patients with a first episode of distal DVT. Distal DVT encompasses thromboses located below the knee in the calf veins (ie, the popliteal vein is not involved). Most calf vein DVTs are located in the posterior tibial and peroneal veins, while anterior tibial and muscular vein DVTs are uncommon. Distal DVT can only be detected by whole-leg ultrasonography.

DVT: deep venous thrombosis; PE: pulmonary embolism; COVID-19: coronavirus disease 2019; IVC: inferior vena cava.

* When left untreated, approximately one-third of patients with symptomatic isolated distal DVT will develop extension into the proximal veins, most often within the first 2 weeks. If extension does not occur within 2 weeks, it is unlikely to occur. However, patients with a stable clot during 2 weeks of observation may require longer periods of observation.

¶ Some experts choose not to anticoagulate select patients who are considered at a very low risk of embolization and are suitable candidates for surveillance. Such patients include those with minor thrombosis in the muscular veins, those with a negative D-dimer level, those with nondiagnostic ultrasonography results, those with minor symptoms who are without risk factors for extension, and those at high risk of bleeding.

Δ The minimum duration of anticoagulation is 3 months; however, select patients may be candidates for indefinite anticoagulant therapy. Choice of anticoagulant is dependent upon several factors including patient preference, underlying risk factors, cost, and previous history of renal insufficiency, and heparin-induced thrombocytopenia. Refer to UpToDate text for details.

Graphic 131963 Version 3.0

خرید پکیج

Treatment of distal deep venous thrombosis of the lower extremity