Management of Deep Vein Thrombosis: An Update Based on the Revised AWMF S2k Guideline

Birgit Linnemann; Jan Beyer-Westendorf; Christine Espinola-Klein; Katja S. Mühlberg; Oliver J. Müller; Robert Klamroth

doi:10.1055/a-2178-6574

Hämostaseologie, Table of Contents

Hamostaseologie 2024; 44(02): 097-110
DOI: 10.1055/a-2178-6574

Review Article

Management of Deep Vein Thrombosis: An Update Based on the Revised AWMF S2k Guideline

Birgit Linnemann

¹Cardiology III – Angiology, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany

,

Jan Beyer-Westendorf

²Thrombosis Research Unit, Division of Haematology, Department of Medicine I, Carl Gustav Carus University Hospital, University Hospital Carl-Gustav Carus, Dresden, Germany

,

Christine Espinola-Klein

¹Cardiology III – Angiology, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany

,

Katja S. Mühlberg

³Department of Angiology, University Hospital Leipzig, Leipzig, Germany

,

Oliver J. Müller

⁴Department of Internal Medicine III, University Hospital Schleswig - Holstein, Campus Kiel, Kiel, Germany

,

Robert Klamroth

⁵Department of Internal Medicine, Angiology and Haemostaseology, Vivantes Klinikum im Friedrichshain, Berlin, Germany

› Author Affiliations

Abstract

Deep vein thrombosis (DVT) and pulmonary embolism (PE) are the most common manifestations of venous thromboembolism (VTE). Most DVTs affect the lower-extremity veins. Since the symptoms of DVT are non-specific, a prompt and standardised diagnostic work-up is essential to minimise the risk of PE in the acute phase and to prevent thrombosis progression, post-thrombotic syndrome and VTE recurrence in the long-term. Only recently, the AWMF S2k guidelines on Diagnostics and Therapy of Venous Thrombosis and Pulmonary Embolism have been revised. In the present article, we summarize current evidence and guideline recommendations focusing on lower-extremity DVT (LEDVT). Depending on whether the diagnostic work-up is performed by a specialist in vascular medicine or by a primary care physician, different diagnostic algorithms are presented that combine clinical probability, D-dimer testing and diagnostic imaging. The diagnosis of ipsilateral recurrent DVT poses a particular challenge and is presented in a separate algorithm. Anticoagulant therapy is an essential part of therapy, with current guidelines clearly favouring regimens based on direct oral anticoagulants over the traditional sequential therapy of parenteral anticoagulants and vitamin K antagonists. For most DVTs, a duration of therapeutic-dose anticoagulation of at least 3 to 6 months is considered sufficient, and this raises the question of the risk of VTE recurrence after discontinuation of anticoagulation and the need for secondary prophylaxis in the long-term. Depending on the circumstances and trigger factors that have contributed to the occurrence of DVT, management strategies are presented that allow decision-making taking into account the individual bleeding risk and patient's preferences.

Keywords

anticoagulant therapy - deep vein thrombosis - secondary prophylaxis - venous duplex ultrasonography - venous thromboembolism

Full Text

References

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