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Deep vein thrombosis - Management
Basis for recommendation

Anticoagulant drugs

  • CKS recommendations for the use of anticoagulants for deep vein thrombosis (DVT) are based on evidence-based guidelines produced by the British Committee for Standards in Haematology [Winter et al, 2003; Baglin et al, 2006] and the Scottish Intercollegiate Guidelines Network [SIGN, 1999]. These are also consistent with American evidence-based guidelines [ICSI, 2007; Kearon et al, 2008]. There is consensus across these guidelines regarding the principles of treatment, although details of implementation vary.
  • Although expert opinion on the use of anticoagulants for the prevention of future episodes is unanimous, evidence from placebo-controlled trials is absent. Therefore, evidence for the efficacy of these drugs is based on historical usage, known pharmacological effects, and extrapolation from studies on the optimal duration of treatment.

Compression stockings

  • There is good evidence from three randomized controlled trials (RCTs) that the use of compression stockings can significantly reduce the risk of a recurrent episode of DVT, especially when they are combined with other treatments (for example, anticoagulation) [Amaragiri and Lees, 2000]. Stockings may also help prevent post-thrombotic syndrome.
    • The RCTs used compression stockings with a pressure of 30 mmHg to 40 mmHg, or 20 mmHg to 30 mmHg [Amaragiri and Lees, 2000], which most closely corresponds to British Standard class 3 stockings (25 mmHg to 35 mmHg).
    • However, CKS recognizes that class 3 stockings are often poorly tolerated. In this instance, it is preferable to use class 2 stockings (18 mmHg to 24 mmHg), which tend to be better tolerated, rather than forego use completely.

Lifestyle advice

  • It is assumed that an early return to walking may help reduce the risk of further deep vein thrombosis and improve circulation in the affected limb, although there is a lack of objective evidence to prove this. However, there is some evidence from observational studies to suggest it is relatively safe, although there is a lack of evidence of efficacy.
  • Elevating the leg whilst at rest is recommended as a comfort measure.
  • Experts believe it is relatively safe to travel by aeroplane following DVT or pulmonary embolism, provided the person is receiving anticoagulation drugs [British Committee for Standards in Haematology, 2005].

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