Management of Venous Thromboembolism: A Clinical Practice Guideline from the American College of Physicians and the American Academy of Family Physicians

Venous thromboembolism is a common condition affecting 7.1 persons per 10,000 person-years among community residents. Incidence rates for venous thromboembolism are higher in men, African-Americans, and increase substantially with age. It is critical to treat deep venous thrombosis at an early stage to avoid development of further complications, such as pulmonary embolism or recurrent deep venous thrombosis. The target audience for this guideline is all clinicians caring for patients who have been given a diagnosis of deep venous thrombosis or pulmonary embolism. The target patient population is patients receiving a diagnosis of pulmonary embolism or lower-extremity deep venous thrombosis.

[1]  R. C. Marshall,et al.  Current Diagnosis of Venous Thromboembolism in Primary Care: A Clinical Practice Guideline from the American Academy of Family Physicians and the American College of Physicians* , 2007, Annals of Internal Medicine.

[2]  L. Hofmann,et al.  Management of Venous Thromboembolism: A Systematic Review for a Practice Guideline , 2007, Annals of Internal Medicine.

[3]  Roslyn A Stone,et al.  A prediction rule to identify low-risk patients with pulmonary embolism. , 2006, Archives of internal medicine.

[4]  M. Streiff,et al.  The role of vena caval filters in the management of venous thromboembolism. , 2005, Blood reviews.

[5]  M. Prins,et al.  Below-Knee Elastic Compression Stockings To Prevent the Post-Thrombotic Syndrome , 2004, Annals of Internal Medicine.

[6]  J. Douketis,et al.  Comparison of 1 month with 3 months of anticoagulation for a first episode of venous thromboembolism associated with a transient risk factor , 2004, Journal of thrombosis and haemostasis : JTH.

[7]  L. Hofmann,et al.  Comparison of urokinase, alteplase, and reteplase for catheter-directed thrombolysis of deep venous thrombosis. , 2004, Journal of vascular and interventional radiology : JVIR.

[8]  J. Bonnar,et al.  Tinzaparin sodium for thrombosis treatment and prevention during pregnancy. , 2004, American journal of obstetrics and gynecology.

[9]  M. Gent,et al.  Comparison of low-intensity warfarin therapy with conventional-intensity warfarin therapy for long-term prevention of recurrent venous thromboembolism. , 2003, The New England journal of medicine.

[10]  M. Prins,et al.  Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. , 2003, The New England journal of medicine.

[11]  W. Ageno,et al.  Extended Oral Anticoagulant Therapy after a First Episode of Pulmonary Embolism , 2003, Annals of Internal Medicine.

[12]  J. Hirsh,et al.  Suboptimal Monitoring and Dosing of Unfractionated Heparin in Comparative Studies with Low-Molecular-Weight Heparin , 2003, Annals of Internal Medicine.

[13]  P. Ridker,et al.  Long-term, low-intensity warfarin therapy for the prevention of recurrent venous thromboembolism. , 2003, The New England journal of medicine.

[14]  V. Kakkar,et al.  Low-molecular-weight heparin in the acute and long-term treatment of deep vein thrombosis , 2003, Thrombosis and Haemostasis.

[15]  D. Sze,et al.  The safety, efficacy, and pharmacoeconomics of low-dose alteplase compared with urokinase for catheter-directed thrombolysis of arterial and venous occlusions. , 2003, Journal of vascular surgery.

[16]  D. Sze,et al.  Initial Clinical Results of Tenecteplase (TNK) in Catheter-Directed Thrombolytic Therapy , 2002, Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists.

[17]  D. Sze,et al.  Initial clinical results of tenecteplase (TNK) in catheter-directed thrombolytic therapy. , 2002 .

[18]  M. Elsharawy,et al.  Early results of thrombolysis vs anticoagulation in iliofemoral venous thrombosis. A randomised clinical trial. , 2002, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[19]  Yves Gruel,et al.  Comparison of low-molecular-weight heparin and warfarin for the secondary prevention of venous thromboembolism in patients with cancer: a randomized controlled study. , 2002, Archives of internal medicine.

[20]  G. de Lissovoy,et al.  Management of acute proximal deep vein thrombosis: pharmacoeconomic evaluation of outpatient treatment with enoxaparin vs inpatient treatment with unfractionated heparin. , 2002, Chest.

[21]  Ruizong Li,et al.  Catheter-directed thrombolysis in deep venous thrombosis with use of reteplase: immediate results and complications from a pilot study. , 2002, Journal of vascular and interventional radiology : JVIR.

[22]  C. Fegan,et al.  Outpatient management of DVT using low molecular weight heparin and a hospital outreach service. , 2002, Clinical and laboratory haematology.

[23]  Brian J. Smith,et al.  Cost comparison of at‐home treatment of deep venous thrombosis with low molecular weight heparin to inpatient treatment with unfractionated heparin , 2002, Internal medicine journal.

[24]  L. Barbour,et al.  ACOG practice bulletin , 2001 .

[25]  A. Borel‐Derlon,et al.  Venous thromboembolism during pregnancy: a retrospective study of enoxaparin safety in 624 pregnancies , 2001, BJOG : an international journal of obstetrics and gynaecology.

[26]  M Gent,et al.  Prevention and treatment of postphlebitic syndrome: results of a 3-part study. , 2001, Archives of internal medicine.

[27]  W. Ageno,et al.  Three months versus one year of oral anticoagulant therapy for idiopathic deep venous thrombosis. Warfarin Optimal Duration Italian Trial Investigators. , 2001, The New England journal of medicine.

[28]  LaurentPinede,et al.  Comparison of 3 and 6 Months of Oral Anticoagulant Therapy After a First Episode of Proximal Deep Vein Thrombosis or Pulmonary Embolism and Comparison of 6 and 12 Weeks of Therapy After Isolated Calf Deep Vein Thrombosis , 2001 .

[29]  E. Grau,et al.  Home treatment of deep venous thrombosis with low molecular weight heparin: Long‐term incidence of recurrent venous thromboembolism , 2001, American journal of hematology.

[30]  D. Berman,et al.  Outpatient treatment of deep venous thrombosis: a clinical care pathway managed by the emergency department. , 2001, Annals of emergency medicine.

[31]  A. AbuRahma,et al.  Endovascular caval interruption in pregnant patients with deep vein thrombosis of the lower extremity. , 2001, Journal of vascular surgery.

[32]  M. Prins,et al.  For the initial treatment of venous thromboembolism: are all low-molecular-weight heparin compounds the same? , 2000, Thrombosis research.

[33]  J. Ribera,et al.  Low Molecular Weight Heparin (Enoxaparin) Versus Oral Anticoagulant Therapy (Acenocoumarol) in the Long-Term Treatment of Deep Venous Thrombosis in the Elderly: a Randomized Trial , 2000, Thrombosis and Haemostasis.

[34]  P. Romano,et al.  A population-based study of the effectiveness of inferior vena cava filter use among patients with venous thromboembolism. , 2000, Archives of internal medicine.

[35]  K. Ouriel,et al.  Reteplase in the treatment of peripheral arterial and venous occlusions: a pilot study. , 2000, Journal of vascular and interventional radiology : JVIR.

[36]  A. Comerota,et al.  Catheter-directed thrombolysis for iliofemoral deep venous thrombosis improves health-related quality of life. , 2000, Journal of vascular surgery.

[37]  H. Boccalon,et al.  Clinical outcome and cost of hospital vs home treatment of proximal deep vein thrombosis with a low-molecular-weight heparin: the Vascular Midi-Pyrenees study. , 2000, Archives of internal medicine.

[38]  H. Eriksson,et al.  Recurrent venous thromboembolism after deep vein thrombosis: incidence and risk factors. , 2000, Archives of internal medicine.

[39]  A. Nicolaides,et al.  Comparison of Low-Molecular-Weight Heparin, Administered Primarily at Home, with Unfractionated Heparin, Administered in Hospital, and Subcutaneous Heparin, Administered at Home for Deep-Vein Thrombosis , 1999, Angiology.

[40]  S. Mckean,et al.  An outpatient program to treat deep venous thrombosis with low-molecular-weight heparin. , 1999, Effective clinical practice : ECP.

[41]  S. Carrera,et al.  Venographic comparison of subcutaneous low-molecular weight heparin with oral anticoagulant therapy in the long-term treatment of deep venous thrombosis. , 1999, Journal of vascular surgery.

[42]  G. Sanders,et al.  Low-Molecular-Weight Heparins Compared with Unfractionated Heparin for Treatment of Acute Deep Venous Thrombosis: A Cost-Effectiveness Analysis , 1999, Annals of Internal Medicine.

[43]  T. Hastie,et al.  Low-Molecular-Weight Heparins Compared with Unfractionated Heparin for Treatment of Acute Deep Venous Thrombosis , 1999, Annals of Internal Medicine.

[44]  G. Seabrook,et al.  Catheter-directed thrombolysis for lower extremity deep venous thrombosis: report of a national multicenter registry. , 1999, Radiology.

[45]  M Gent,et al.  A comparison of three months of anticoagulation with extended anticoagulation for a first episode of idiopathic venous thromboembolism. , 1999, The New England journal of medicine.

[46]  L. Melton,et al.  Predictors of survival after deep vein thrombosis and pulmonary embolism: a population-based, cohort study. , 1999, Archives of internal medicine.

[47]  A. AbuRahma,et al.  Management of Deep Vein Thrombosis of the Lower Extremity in Pregnancy: A Challenging Dilemma , 1999, The American surgeon.

[48]  D. Brewer.  Should low-molecular-weight heparins replace unfractionated heparin as the agent of choice for adults with deep venous thrombosis? , 1998, The Journal of family practice.

[49]  Joan Costa,et al.  Secondary Prevention of Venous Thromboembolism: A Role for Low-Molecular-Weight Heparin , 1998, Pathophysiology of Haemostasis and Thrombosis.

[50]  M. Prins,et al.  Low molecular weight heparin versus unfractionated heparin in the initial treatment of venous thromboembolism. , 1998, Current opinion in pulmonary medicine.

[51]  F. Barral,et al.  A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. Prévention du Risque d'Embolie Pulmonaire par Interruption Cave Study Group. , 1998, The New England journal of medicine.

[52]  M. Caldwell,et al.  Iliofemoral deep venous thrombosis: safety and efficacy outcome during 5 years of catheter-directed thrombolytic therapy. , 1997, Journal of vascular and interventional radiology : JVIR.

[53]  M. Dolovich.  Rationale for spacer use in children , 1997, Pediatric pulmonology. Supplement.

[54]  H. Büller,et al.  Randomised trial of effect of compression stockings in patients with symptomatic proximal-vein thrombosis , 1997, The Lancet.

[55]  O. Linder,et al.  The duration of oral anticoagulant therapy after a second episode of venous thromboembolism. The Duration of Anticoagulation Trial Study Group. , 1997, The New England journal of medicine.

[56]  P. Howard.  Dalteparin: A Low-Molecular-Weight Heparin , 1997, The Annals of pharmacotherapy.

[57]  J. Hirsh,et al.  A comparison of low-molecular-weight heparin administered primarily at home with unfractionated heparin administered in the hospital for proximal deep-vein thrombosis. , 1996, The New England journal of medicine.

[58]  P. Bossuyt,et al.  Treatment of venous thrombosis with intravenous unfractionated heparin administered in the hospital as compared with subcutaneous low-molecular-weight heparin administered at home. The Tasman Study Group. , 1996, The New England journal of medicine.

[59]  A R Jadad,et al.  Assessing the quality of reports of randomized clinical trials: is blinding necessary? , 1996, Controlled clinical trials.

[60]  M. Gent,et al.  Optimal Duration of Oral Anticoagulant Therapy: A Randomized Trial Comparing Four Weeks with Three Months of Warfarin in Patients with Proximal Deep Vein Thrombosis , 1995, Thrombosis and Haemostasis.

[61]  J. Hirsh,et al.  Low Molecular Weight Heparins (LMWH) in the Treatment of Patients with Acute Venous Thromboembolism , 1995, Thrombosis and Haemostasis.

[62]  Olle Linder,et al.  A Comparison of Six Weeks with Six Months of Oral Anticoagulant Therapy after a First Episode of Venous Thromboembolism , 1995 .

[63]  M. Pini,et al.  Low Molecular Weight Heparin versus Warfarin in the Prevention of Recurrences after Deep Vein Thrombosis , 1994, Thrombosis and Haemostasis.

[64]  A. AbuRahma,et al.  Management of deep vein thrombosis of the lower extremity in pregnancy. , 1993, The West Virginia medical journal.

[65]  J. Bligh,et al.  HOME TREATMENT OF DEEP-VEIN THROMBOSIS , 1988, The Lancet.

[66]  M. Prins,et al.  Below-knee elastic compression stockings to prevent the post-thrombotic syndrome: A randomized, controlled trial , 2005 .

[67]  M. Prins,et al.  Fixed dose subcutaneous low molecular weight heparins versus adjusted dose unfractionated heparin for venous thromboembolism. , 2004, The Cochrane database of systematic reviews.

[68]  M. Prins,et al.  Fixed dose subcutaneous low molecular weight heparins versus adjusted dose infractionated heparin for venous thromboembolism [Cochrane review] , 2004 .

[69]  M. Ebell,et al.  Strength of recommendation taxonomy (SORT): a patient-centered approach to grading evidence in the medical literature. , 2004, The Journal of the American Board of Family Practice.

[70]  L. Tamariz,et al.  Diagnosis and treatment of deep venous thrombosis and pulmonary embolism. , 2003, Evidence report/technology assessment.

[71]  D. Coyle,et al.  The outpatient treatment of deep vein thrombosis delivers cost savings to patients and their families, compared to inpatient therapy. , 2003, Thrombosis research.

[72]  L. Tamariz,et al.  Diagnosis and Treatment of Deep Venous Thrombosis and Pulmonary Embolism: Summary , 2003 .

[73]  D. Huse,et al.  Outpatient treatment of venous thromboembolism with low-molecular-weight heparin: an economic evaluation. , 2002, The American journal of managed care.

[74]  W. Ageno,et al.  Selecting patients for home treatment of deep vein thrombosis: the problem of cancer. , 2002, Haematologica.

[75]  A. Martínez,et al.  Low molecular weight heparin versus oral anticoagulants in the long-term treatment of deep venous thrombosis. , 2001, Journal of vascular surgery.

[76]  M. Kovacs,et al.  Outpatient Treatment of Pulmonary Embolism with Dalteparin , 2000, Thrombosis and Haemostasis.

[77]  M. Martínez-González,et al.  Do the low molecular weight heparins improve efficacy and safety of the treatment of deep venous thrombosis? A meta-analysis. , 2000, Haematologica.

[78]  L. Melton,et al.  Predictors of recurrence after deep vein thrombosis and pulmonary embolism: a population-based cohort study. , 2000, Archives of internal medicine.

[79]  M. Prins,et al.  Fixed dose subcutaneous low molecular weight heparins versus adjusted dose unfractionated heparin for venous thromboembolism. , 2000, The Cochrane database of systematic reviews.

[80]  S. Lopaciuk,et al.  Low Molecular Weight Heparin versus Acenocoumarol in the Secondary Prophylaxis of Deep Vein Thrombosis , 1999, Thrombosis and Haemostasis.

[81]  G. Sanders,et al.  Annals of Internal Medicine Low-Molecular-Weight Heparins Compared with Unfractionated Heparin for Treatment of Acute Deep Venous Thrombosis A Cost-Effectiveness Analysis , 1999 .

[82]  G. Lärfars,et al.  A comparison of six weeks with six months of oral anticoagulant therapy after a first episode of venous thromboembolism. Duration of Anticoagulation Trial Study Group. , 1995, The New England journal of medicine.

[83]  T. Schacker,et al.  Annals of Internal Medicine , 1992 .