Key Points
ÎIn all patients who receive extended anticoagulant therapy, the continuing use of treatment should be reassessed at periodic intervals (eg, annually).
Treatment Acute Leg DVT
ÎThe ACCP recommends early initiation of VKA (eg, same day as parenteral therapy is started) over delayed initiation, and continuation of parenteral anticoagulation for a minimum of 5 days and until the international normalized ratio (INR) is 2.0 or above for at least 24 h (1-B).
• In patients treated with VKA, the ACCP recommends a therapeutic INR range of 2.0-3.0 (target INR 2.5) over a lower (INR < 2) or higher (INR 3.0-5.0) range for all treatment durations (1-B).
ÎIf the patient is treated with vitamin K antagonist (VKA) therapy, the American College of Chest Physicians (ACCP) recommends initial treatment with parenteral anticoagulation (low-molecular-weight heparin [LMWH], fondaparinux, intravenous [IV] unfractionated heparin [UFH], or subcutaneous [subcut] UFH) over no such initial treatment (1-B).
ÎIf the patient is treated with LMWH, the ACCP suggests once- over twice-daily administration (2-C).
Remark: This recommendation applies only when the approved once-daily regimen uses the same daily dose as the twice-daily regimen (ie, the once-daily injection contains double the dose of each twic edaily injection). It also places value on avoiding an extra injection per day.
ÎThe ACCP suggests LMWH or fondaparinux over IV UFH (2-C) and over subcut UFH (2-B for LMWH; 2-C for fondaparinux).
Remark: Local considerations such as cost, availability, and familiarity of use dictate the choice between fondaparinux and LMWH.
ÎIf the patient undergoes thrombosis removal, the ACCP recommends the same intensity and duration of anticoagulant therapy as in comparable patients who do not undergo thrombosis removal (1-B).
ÎIf there are contraindications to anticoagulation, the ACCP recommends the use of an IVC filter (1-B).
ÎThe ACCP recommends against the use of an inferior vena cava (IVC) filter in addition to anticoagulants. (1-B).
ÎThe ACCP suggests early ambulation over initial bed rest (2-C).
Remark: If edema and pain are severe, ambulation may need to be deferred. The ACCP suggests the use of compression therapy in these patients.
