Deep Vein Thrombosis - Related Resources

Cochrane reviews

Drug therapy

• There is insufficient evidence on the use of a 10-mg or a 5-mg loading dose for initiation of warfarin for venous thromboembolism Optimal Loading Dose of Warfarin for the Initiation of Oral Anticoagulation.
• Treatment of vitamin K antagonists reduces the risk of recurrent venous thromboembolism as long as it is used. However, the absolute risk of recurrence declines over time, while the risk of major bleeding remains Duration of Anticoagulant Therapy in Venous Thromboembolism.
• Low-molecular weight heparins are equally effective and safer as vitamin K antagonists in the long-term treatment of symptomatic venous thromboembolism (but they are much more costly and need subcutaneous administration) Vitamin K Antagonists or Low-Molecular Weight Heparin for Venous Thromboembolism.
• The number of adverve events with low-molecular-weight heparin (LMWH) during pregnancy is small, but there are no RCTs comparing LMWH with unfractionated heparin .
• Once daily administration of low molecular weight heparin (LMWH) for the initial treatment of venous thromboembolism appears to be as safe and effective as a twice daily regimenOnce Versus Twice Daily Low Molecular Weight Heparin for the Initial Treatment of Venous Thromboembolism.
• Low molecular weight heparin may reduce mortality compared to unfractionated heparin in the initial treatment of venous thromboembolism in patients with cancer Anticoagulation for the Intial Treatment of Venous Thromboembolism in Patients with Cancer.
• For the long term treatment of venous thromboembolism in patients with cancer, low molecular weight heparin compared to vitamin K antagonist appears to reduce venous thromboembolic events but not death Anticoagulation for the Long Term Treatment of Venous Thromboembolism in Patients with Cancer.
• There is insufficient evidence on the effectiveness of subcutaneous unfractionated heparin for the treatment of venous thromboembolism compared to other treatment modalities Subcutaneous Unfractionated Heparin for the Initial Treatment of Venous Thromboembolism.
• LMWH is more effective and safer than unfractionated heparin for the initial treatment of venous thromboembolism. LMWH significantly reduces the occurrence of major haemorrhage during initial treatment and overall mortality at follow up Low-Molecular-Weight Heparins (Lmwh) Versus Unfractionated Heparin for Venous Thromboembolism.
• There appears to be lower incidence of heparin-induced thrombocytopenia (HIT) and HIT complicated by venous thromboembolism in postoperative patients undergoing thromboprophylaxis with low molecular weight heparin (LMWH) compared with unfractionated heparin (UFH).
• Rosuvastatin may reduce the incidence of venous thromboembolic events Statins for Primary Prevention of Venous Thromboembolism.

Other evidence summaries

Drug therapy

• Long-term anticoagulant therapy after first episode of venous thromboembolism reduces the risk of recurrence without significantly increasing the incidence of bleeding events Long Versus Short Duration of Anticoagulant Therapy after a First Episode of Venous Thromboembolism.
• Conventional-intensity warfarin therapy appears to be more effective than low-intensity warfarin therapy for the long-term prevention of recurrent venous thromboembolism. The low-intensity warfarin regimen does not reduce the risk of clinically important bleeding Low-Intensity Warfarin for Long-Term Prevention of Venous Thromboembolism.

Diagnostics

• Plethysmography and rheography techniques appear to have inadequate diagnostic performance to act as a stand-alone test in deep vein thrombosis diagnosis, although they add diagnostic value Plethysmography and Rheography in the Diagnosis of Deep Vein Thrombosis.

Others

• In patients who discontinue anticoagulant therapy after a first episode of venous thromboembolism (VTE), the risk of fatal pulmonary embolism may be under 1 per 100 person-years, and slightly larger for fatal PE than for fatal bleeding. The risk of fatal pulmonary embolism increases with age and if the initial VTE is idiopathic Fatal Pulmonary Embolism after Discontinuing Anticoagulant Therapy for First Episode of Venous Thromboembolism Vs Fatal Bleeding during Continued Anticoagulation.

Clinical guidelines

• Kearon C, Akl EA, Ornelas J et al. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest 2016;149(2):315-52. [PubMed]
• Guyatt GH, Akl EA, Crowther M et al. Executive summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141(2 Suppl):7S-47S. [PubMed]
• Bates SM, Jaeschke R, Stevens SM et al. Diagnosis of DVT: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141(2 Suppl):e351S-418S. [PubMed]
• Kearon C, Akl EA, Comerota AJ et al. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141(2 Suppl):e419S-94S. [PubMed]

Literature