cardiovascular disorders
Deep Venous Thrombosis (DVT)
Key Points
Symptoms and signs are nonspecific, so clinicians must be alert, particularly in high-risk patients. Low-risk patients may have D-dimer testing, as a normal result essentially excludes deep venous thrombosis (DVT); others should have ultrasonography. Treatment initially is with an injectableheparin(unfractionated or low molecular weightheparin[LMWH]) followed by an oral anticoagulant (warfarin,dabigatran, or afactor Xainhibitor) or a LMWH; alternatively, the oralfactor Xainhibitorsrivaroxabanandapixabanmay be used for initial and ongoing treatment. Duration of treatment is typically 3 or 6 months, depending on the presence and nature of risk factors; certain patients require lifelong treatment. Preventive treatment is required for bedbound patients with major illness and/or those undergoing certain surgical procedures. Early mobilization, leg elevation, and an anticoagulant are the recommended preventive measures; patients who should not receive anticoagulants may benefit from intermittent pneumatic compression devices, elastic stockings, or both. 