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Medical Pearls from the Internet Medical Association

Acute deep venous thromboembolism (DVT) can be treated as an outpatient in most cases, with low molecular weight heparin (LMWH), vitamin K antagonists, direct factor Xa inhibitors, or direct factor IIa inhibitors.

Comment: This is an important review updating the recommended therapy for DVT and PE. The authors recommend that initial therapy with vitamin K antagonists alone is not usually recommended, and unfractionated or low molecular weight heparin is usually given for 5 days and continued until the INR is optimized. LMWH can be given as an outpatient. Rivaroxaban is useful as monotherapy for both DVT and pulmonary embolism (PE). As with LMWH, rivaroxaban is used with caution in patients with renal insufficiency. The authors state that in the U.S., outpatient treatment of PE is not universally accepted although this is common practice in many centers in Canada. About a third to a half of patients with PE are low risk, and these patients are candidates for outpatient therapy. Isolated calf DVT can often be treated by observation by ultrasonography. If the thrombus demonstrates no extension after one to two weeks, anticoagulation can be withheld. The minimum duration of anticoagulation is 3 months. The authors also review the indications for thrombolysis and insertion of an inferior vena cava filter, which can be useful but only in rare circumstances. Special circumstances exist when the etiology is malignancy, when long term (6 months or more) LMWH is often used.

JAMA. 2014 Feb 19;311(7):717-28.    (retrieved Mar, 2014). There are currently 885 pearls in the database. While every attempt has been made to ensure accuracy, mistakes can and do occur. Use databank at your own risk. All pearls © 2019 by the Internet Medical Association. Click Here to view more medical pearls.