Clinical Review

Management of deep vein thrombosis and prevention of post-thrombotic syndrome

BMJ 2011; 343 doi: 10.1136/bmj.d5916 (Published 31 October 2011)
Cite this as: BMJ 2011;343:d5916

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  1. R H W Strijkers, PhD student, venous surgery1,
  2. A J ten Cate-Hoek, thrombosis specialist and clinical epidemiologist2,
  3. S F F W Bukkems, resident in physiatry3,
  4. C H A Wittens, vascular surgeon, professor in venous surgery14
  1. 1Department of Vascular Surgery and Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, Limburg, 6202 AZ, Netherlands
  2. 2Laboratory for Clinical Thrombosis and Haemostasis and Laboratory of Haematology, Department of Internal Medicine and Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
  3. 3Department of Physiatry, VieCuri Medical Centre, Venlo, the Netherlands
  4. 4Department of Vascular Surgery, University Hospital RWTH Aachen, Nordrhein-Westfalen, Germany
  1. Correspondence to: C H A Wittens c.wittens{at}me.com

Summary points

  • Suspect deep vein thrombosis (DVT) in patients who present with sudden swelling, redness, and pain of the calf or leg

  • Standard treatment is anticoagulation for at least three months, daily wearing of compressive stockings for two years, and immediate mobilisation

  • Anticoagulation protects against pulmonary embolism but post-thrombotic syndrome is common after DVT

  • Post-thrombotic syndrome is a chronic debilitating condition seen in about 43% of patients with DVT within two years

  • Patients present with a painful heavy leg and may also have cramps, paraesthesia, and pruritus

  • Catheter directed thrombolysis for DVT is a new treatment under study that may improve quality of life and reduce the risk of post-thrombotic syndrome

The annual global incidence of deep vein thrombosis (DVT) of the leg is 1.6 per 1000.1 Classically, venous thrombosis of a lower limb begins in a deep calf vein and propagates more proximally. Symptoms include swelling, pain, and redness of the leg, depending on the vein segment(s) involved (see table 1⇓).2 Patients are at risk of pulmonary embolism.3 Despite optimal conservative treatment with anticoagulation and compression, one in four patients develops a post-thrombotic syndrome within one year,2 and one in three develops a recurrent DVT within five years.4 Patients with post-thrombotic syndrome have poor quality of life.5 A more aggressive approach to treatment, such as removal of early thrombus using catheter directed thrombolysis, might improve outcomes for patients with DVT compared with standard anticoagulation treatment.4 5 6 7 8 9 10 11 12 We review standard and new, more aggressive, management of DVT for the generalist reader, drawing from recent guidelines, cohort studies, small randomised controlled trails, and meta-analyses. All authors are investigators in the CAVA trial, which is one of three randomised controlled trials currently investigating outcomes after treatment with catheter …

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