Intended for healthcare professionals

Clinical Review

Diagnosis, investigation, and management of deep vein thrombosis

BMJ 2003; 326 doi: (Published 29 May 2003) Cite this as: BMJ 2003;326:1180

Re: Deep Venous Thrombosis is a chronic disease--Prevention is important

Thank you for your comments regarding the prevention of DVT.

As the diagnosis, investigation and management of DVT is quite a
broad topic it was difficult to confine the article to 2000 words and so I
could not include a paragraph on thromboprophylaxis. Moreover, we were
restricted to 25 references.

I think that an up to date evidence-based review on the prevention of
DVT is important and topical and warrants a complete paper rather than a

I have almost finished a review on DVT and air travel which I hope to
get published. This article will include all the evidence for the various
preventive measures for DVT.

If patients with a high risk of DVT (such as a recent knee
replacement) need to fly then it is debateable what advice to give. All
people should avoid dehydration and do simple in-flight exercise. The use
of compression stockings or flight socks could also be indicated. However,
depending on the circumstances, my own practice in high risk patients is
to recommend self-injection of low molecular weight heparin (although
there is no license for this indication in the UK). Some haematologists
recommend taking low dose warfarin without INR monitoring.

I agree that for first episode proximal DVT the evidence is that
treatment with warfarin should be for 6 months. However, there is no
consensus on for how long calf vein DVT should be treated. Some clinicians
recommend 6 months whereas other clinicians recommend warfarin for 6 weeks
or 3 months. Some years ago calf vein DVT was considered by some to be a
relatively benign condition which did not warrant treatment. However,
there is now much evidence that calf vein DVT is far from being a benign
condition as the thrombosis can propagate above the knee.

Thank you for interest in this topic.

Competing interests:  
I have been reimbursed by Pharmacia, the makers of Fragmin, for attending a conference

Competing interests: No competing interests

03 June 2003
Clive Tovey
Consultant A&E
A&E Department, Prince Charles Hospital, Merthyr Tydfil, Mid Glamorgan, Wales CF47 9DT