Antithrombotic Therapy for VTE Disease

Treatment ÎIf home circumstances are adequate, the ACCP recommends initial treatment at home over treatment in hospital (1-B). Remark: The recommendation is conditional on the adequacy of home circumstances: well-maintained living conditions, strong support from family or friends, phone access, and ability to return to the hospital quickly if there is deterioration. It is also conditional on the patient feeling well enough to be treated at home (eg, does not have severe leg symptoms or comorbidity). Patients who prefer the security of the hospital to the convenience and comfort of home are likely to choose hospitalization over home treatment. ÎIf the DVT is provoked by surgery or a nonsurgical transient risk factor, the ACCP recommends treatment with anticoagulation for 3 months over • treatment for a shorter period (1-B) • treatment for a longer time-limited period (eg, 6 or 12 months) (1-B) • extended therapy if there is a high bleeding risk (1-B). Remark: The ACCP suggests treatment with anticoagulation for 3 months over extended therapy if there is a low or moderate bleeding risk (2-B). ÎFor an unprovoked DVT of the leg (isolated distala or proximal), the ACCP recommends treatment with anticoagulation for at least 3 months over treatment for a shorter duration (1-B). (See Duration of Anticoagulation by Cause table on Page 9.) ÎIn patients with active cancer, if the risk of bleeding is not high, the ACCP recommends extended anticoagulant therapy over 3 months of therapy (1-B), and if there is a high bleeding risk, the ACCP suggests extended anticoagulant therapy (2-B). Î In patients with cancer, the ACCP suggests LMWH over VKA therapy (2-B). In patients with DVT and cancer who are not treated with LMWH, the ACCP suggests VKA over dabigatran or rivaroxaban for long-term therapy (2-B).b ÎIn patients without cancer, the ACCP suggests VKA therapy over LMWH for long-term therapy (2-C). For patients with DVT and no cancer who are not treated with VKA therapy, the ACCP suggests LMWH over dabigatran or rivaroxaban for long-term therapy (2-C).b ÎIn patients with DVT of the leg who receive extended therapy, the ACCP suggests treatment with the same anticoagulant chosen for the first 3 months (2-C). ÎIn patients who are incidentally found to have asymptomatic DVT of the leg, the ACCP suggests the same initial and long-term anticoagulation as for comparable patients with symptomatic DVT (2-B). ÎIn patients with acute symptomatic DVT of the leg, the ACCP suggests the use of compression stockings (2-B). Remark: Compression stockings should be worn for 2 years, and the ACCP suggests beyond that if patients have developed PTS and find the stockings helpful. Patients who place a low value on preventing PTS or a high value on avoiding the inconvenience and discomfort of stockings are likely to decline stockings. 1

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