Version July 2025
DVT: deep venous thrombosis; IVC: inferior vena cava; PE: pulmonary embolism.
* Many patients (up to 40 percent in some studies) with isolated distal DVT resolve without receiving anticoagulation, while others may experience proximal propagation of thrombosis and embolization. If extension does not occur within two weeks, it is unlikely to occur.
¶ Conversely, presence of features associated with low risk of embolization include those with no symptoms or risk factors for proximal extension, DVT confined to the muscular veins, and D-dimer level <500 ng/mL. We additionally take patient preference into account when deciding on initiation of therapeutic anticoagulation versus surveillance imaging.
Δ IVC filters are considered only in those who experience development of a proximal DVT during surveillance, and there are absolute contraindications to anticoagulation or prohibitively high bleeding risk.
◊ The minimum duration of anticoagulation is three months; however, select patients may be candidates for indefinite anticoagulant therapy. Choice of anticoagulant is dependent upon several factors including hemodynamic stability, anticipated need for discontinuation, comorbidities, patient preference, cost, and previous history of renal insufficiency and heparin-induced thrombocytopenia. Refer to UpToDate text for details.
