Deep vein thrombosis

Last updated: September 21, 2023

Summarytoggle arrow icon

Deep vein thrombosis (DVT) is the formation of a blood clot within the deep veins, most commonly those of the lower extremities. The main risk factors for DVT are vascular endothelial damage (e.g., surgery or trauma), venous stasis (e.g., immobility), and hypercoagulability (e.g., thrombophilia), collectively referred to as the Virchow triad. Symptoms include edema, warmth, and dull pain of the affected extremity. Patients may also present with features of pulmonary embolism (PE), a severe complication of DVT. The Wells criteria for DVT are used to determine the pretest probability (PTP) of DVT. The initial test of choice for DVT is D-dimer in patients with a low PTP and venous ultrasound (US) in patients with moderate or high PTP. A negative D-dimer assay (i.e., levels < 500 ng/mL) allows DVT to be ruled out, while a positive D-dimer (levels ≥ 500 ng/mL) is nonspecific and requires a venous ultrasound to confirm the diagnosis. Noncompressibility of the affected vein is the most important sonographic feature of DVT. Primary treatment with long-term anticoagulation for 3–6 months is recommended in all patients with DVT, with the exception of isolated asymptomatic distal DVT, for which expectant management with serial ultrasound may be considered, as the risk of postthrombotic sequelae is low. Secondary prevention (i.e., anticoagulation extended indefinitely after completion of primary treatment) is also recommended for select patients, depending on the extent and etiology of the DVT and on the patient's bleeding risk. Catheter-directed thrombolysis or thrombectomy may be considered for limb-threatening ischemia, acute iliofemoral DVT, and patients with contraindications to anticoagulation. Primary prevention of VTE is recommended in patients at risk of DVT or PE (e.g., seriously ill medical patients, most surgical patients, and long-distance travelers with additional risk factors for VTE) and includes mechanical and pharmacological measures.

Definitiontoggle arrow icon

Etiologytoggle arrow icon

Any factor that causes hypercoagulability, endothelial damage, and/or venous stasis can cause DVT (see “Virchow triad”).

Risk factors for venous thromboembolism [6][7]
Transient risk factors Chronic risk factors

Remember DVT risk factors using the mnemonic “THROMBOSIS”: Travel, Hypercoagulable/HRT, Recreational drugs, Old (> 60), Malignancy, Blood disorders, Obesity/Obstetrics, Surgery/Smoking, Immobilization, Sickness (CHF/MI, IBD, nephrotic syndrome, vasculitis)!


Pathophysiologytoggle arrow icon

The Virchow triad

The Virchow triad refers to the three main pathophysiological components of thrombus formation.

  1. Hypercoagulability: increased platelet adhesion, thrombophilia (e.g., factor V Leiden mutation), use of oral contraceptives, pregnancy
  2. Endothelial damage: Inflammatory or traumatic vessel injuries can lead to activation of clotting factors through contact with exposed subendothelial collagen.
  3. Venous stasis: varicosis, external pressure on the extremity, immobilization (e.g., hospitalization, bed rest, long flights or bus rides), local application of heat

To remember the three pathophysiological components of thrombus formation, think: “HE'S Virchow”: H-Hypercoagulability, E-Endothelial damage, S-Stasis.


Clinical featurestoggle arrow icon

Deep vein thrombosis may be asymptomatic.


Subtypes and variantstoggle arrow icon

Phlegmasia cerulea dolens

Upper extremity deep vein thrombosis (UEDVT) [16]




Clinical features

  • Symptoms tend to be more severe with proximal UEDVT than with distal UEDVT.
  • Acute thrombosis
    • Discoloration, swelling, and/or pain in the affected arm
    • Superficial venous engorgement
  • Chronic thrombosis
    • Often asymptomatic until complete occlusion occurs
    • Even with complete occlusion, symptoms are often nonspecific or minimal as drainage through collateral veins can partially compensate for occlusion.

Management [17][18][19]

Differential diagnosis


Pretest probability of DVTtoggle arrow icon

Modified Wells criteria for deep vein thrombosis [21][22][23]
Criteria Score
Medical history Active cancer + 1
Previously documented DVT + 1
Immobilization Paralysis, paresis, or recent (cast) immobilization of lower extremity + 1

Recently bedridden for ≥ 3 days OR underwent major surgery within the past 12 weeks under general/local anesthesia

+ 1
Clinical features Tenderness localized along the deep venous system + 1
Swelling of the entire leg + 1

Calf swelling ≥ 3 cm compared to the contralateral leg

+ 1
Pitting edema confined to the symptomatic leg + 1
Distended collateral superficial veins (nonvaricose) + 1
Differential diagnosis Alternative diagnosis as likely as or more likely than DVT - 2

Interpretation (pretest probability for DVT) [17]

  • 0: low
  • 1–2: intermediate
  • ≥ 3: high

The Wells score can overestimate the probability of DVT in patients with concomitant signs of lower extremity cellulitis due to overlap in the clinical manifestations. [24]

Diagnosticstoggle arrow icon

Diagnostic approach for suspected lower-extremity DVT [4][17][25]

This approach is valid for evaluating a first-episode or recurrent lower extremity DVT. [17]

  • Calculate the pretest probability (PTP) using Wells criteria for DVT.
  • Check D-dimer first for low PTP (initial D-dimer is not diagnostically helpful for intermediate and high PTP). ; [26]
    • Negative (< 500 ng/mL): DVT ruled out
    • Positive (≥ 500 ng/mL): Possible DVT; Proceed to venous US.
  • Obtain venous ultrasound (US) for intermediate or high PTP, or low PTP with positive D-Dimer [25]
    • Negative US
      • Intermediate and low PTP: DVT ruled out
      • High PTP: Repeat venous US within a week if no alternate diagnosis. [4]
    • Positive US: DVT confirmed; Screen for an underlying cause if no risk factors for DVT are identified on initial evaluation.
    • Inconclusive US: Consider venography, CT venography, or MR venography.

A negative D-dimer can help rule out DVT without venous ultrasound in patients with low pretest probability. It is not helpful for patients with intermediate or high pretest probability.

The positive yield of investigations for concomitant DVT (i.e., using the Wells score, D-Dimer, and/or venous ultrasound) is low for patients with a high likelihood of lower extremity cellulitis. A selective rather than routine approach to evaluating for DVT is preferred in these patients to avoid unnecessary testing. [24]

Initial evaluation of DVT

Based on the patient's pretest probability, the initial test to evaluate for DVT may be either D-dimer or compression ultrasound.

Severe swelling and edema with concomitant coldness, cyanosis, and pulselessness should raise concern for phlegmasia cerulea dolens, which requires emergency surgery.

D-dimer [17][25]

  • Indication: preferred initial test for nonpregnant patients with a low PTP of DVT (Wells score = 0)
  • Interpretation
    • Cutoff for normal range is typically 500 ng/mL
    • Some centers use age-adjusted D-dimer cutoffs (See also “Diagnostics” in “Pulmonary embolism”) [27][28][29]
  • Accuracy
    • High sensitivity (∼ 96%)
    • Low specificity (∼ 36%) [4]
    • Not reliable for ruling out DVT in patients with intermediate or high PTP

In patients with a low pretest probability of DVT, a negative D-dimer (< 500 ng/mL) rules out DVT. [17]

A positive D-dimer alone does not confirm DVT. [17]

Lower extremity venous ultrasound [4][17][25][30]

Compression ultrasound of the whole leg with color Doppler (i.e., duplex scanning) is the most accurate test for diagnosing DVT. [25]

If appropriately trained, consider performing a POCUS study to quickly rule in a proximal DVT. If the study is negative, further investigations (e.g., a whole leg ultrasound study by radiology) may be necessary. [32][33]

Additional evaluation

Routine laboratory studies

These are recommended to assess organ function and bleeding risk prior to anticoagulation.

Venography, CT venography, or MR venography [4][30]

Screening for an underlying cause

Patients with the following may require additional evaluation: unprovoked DVT, unexplained recurrent VTE, and/or a history suggestive of a hypercoagulable state or occult malignancy. [2]

Differential diagnosestoggle arrow icon

In patients with suspected cellulitis AND risk factors for DVT or no response to antibiotics, consider compression ultrasound to rule out DVT. [24]

The differential diagnoses listed here are not exhaustive.

Superficial thrombophlebitistoggle arrow icon


Risk factors

Risk factors for concomitant DVT [19][38]

Clinical features


Superficial thrombophlebitis is typically a clinical diagnosis. The primary differential diagnoses are localized skin or soft tissue inflammation (e.g., cellulitis, vasculitis) [38][41]

Treatment [19][42]

All patients should be evaluated and treated for concomitant pulmonary embolism or DVT.


Treatmenttoggle arrow icon

Approach [7][26]

Consider empiric management of pulmonary embolism in unstable or pulseless patients with obvious signs of DVT. [19][45]

Therapeutic approach to DVT [7][25][26]
Options Indications
Expectant management
(i.e., serial venous ultrasound over 2 weeks)

Primary treatment only
(i.e., anticoagulation for 3–6 months)

Primary treatment PLUS secondary prevention
(i.e., anticoagulation for 3–6 months PLUS extended anticoagulation of indefinite duration)

Advanced therapy
(e.g., catheter-directed thrombolysis, thrombectomy, IVC filter)

Expectant management [7][25][26]

  • Indication: asymptomatic or only mildly symptomatic isolated distal DVT without risk factors for clot extension
  • Relative contraindications
  • Measures
    • Serial venous US for 2 weeks after symptom onset to identify clot extension
    • If evidence of clot extension is:
      • Absent: No further management is required.
      • Confined to distal veins: Consider anticoagulation.
      • Involves proximal veins: Initiate anticoagulation.

Primary treatment (anticoagulation) [7][26][46]

Primary treatment is the duration of anticoagulation required to treat an acute DVT and involves an initial transient period of parenteral anticoagulation (bridging anticoagulation) followed by long-term (typically 3–6 months) oral anticoagulation.

Initial parenteral anticoagulation (for the first 5–10 days)

Treatment with heparin (especially UFH) can cause heparin-induced thrombocytopenia. For early detection, perform regular CBCs.

Long-term anticoagulation (for 3–6 months)

Initial parenteral anticoagulation (with LMWH, fondaparinux, or UFH) should be initiated at the same time as warfarin and before dabigatran and edoxaban. Initial parenteral anticoagulation is not required for patients receiving rivaroxaban or apixaban. [7][26]

Secondary prevention (extended anticoagulation of indefinite duration) [7][26][46]

The decision to extend anticoagulation indefinitely after primary treatment is typically made after balancing the risk of recurrent DVT (e.g., for patients with chronic risk factors) with the bleeding risk on anticoagulation for VTE.

  • Indications: See “Therapeutic approach to DVT.”
  • Options [26]
    • First episode of DVT: Continue the same anticoagulant used for long-term anticoagulation (e.g., warfarin, or DOACs).
    • Recurrent DVT while appropriately anticoagulated
    • Patients wishing to discontinue anticoagulation : Consider aspirin (unless there are contraindications)
  • Monitoring: Reassess bleeding risk periodically (e.g., annually).

Extended anticoagulation is usually not required in patients with a provoked DVT due to a transient or reversible risk factor (e.g., surgery, intravascular catheter). [26][46]

Advanced therapy

These interventions are not routinely indicated.

Supportive care [26]

Disposition [7][26][46]

  • Outpatient therapy is preferred for patients with uncomplicated DVT. [59]
    • Educate the patient regarding prescribed anticoagulation and the recognition of warning signs.
    • Ensure outpatient follow-up within 1–2 weeks.
  • Hospital admission during the acute phase is recommended for patients with:

Prior to discharge, educate patients regarding prescribed anticoagulation and advise them to immediately seek medical attention if they develop worsening pain or swelling, shortness of breath, chest pain, or signs of bleeding.

Estimation of bleeding risk with anticoagulationtoggle arrow icon

Risk factors for bleeding in patients with VTE [26]

Risk assessment

Risk of major bleeding on anticoagulant therapy in patients with VTE [26]
Risk category First 3 months of therapy After 3 months of therapy


(No risk factors)

1.6% 0.8%/year


(1 risk factor)

3.2% 1.6%/year


(≥ 2 risk factors)

12.8% ≥ 6.5%/year

Preventiontoggle arrow icon

VTE prophylaxis refers to the primary prevention of DVT or PE in at-risk individuals and includes general preventive measures, mechanical VTE prophylaxis, and pharmacological VTE prophylaxis. VTE prophylaxis should be chosen based on the presence of risk factors for VTE and estimated risk of bleeding on anticoagulation therapy. [60]

  • General preventive measures
    • Regular exercise
    • Early postoperative mobilization
    • Physiotherapy
    • Avoid certain medications (e.g., OCPs) in patients with thrombophilias (e.g., factor V Leiden).
  • Pharmacological VTE prophylaxis (antithrombotics): LMWH, low-dose UFH, and DOACs are recommended.
  • Mechanical VTE prophylaxis
    • Graduated compression stockings: preferred in long-distance travelers
    • Intermittent pneumatic compression device
      • Preferred in seriously ill medical patients and in surgical patients
      • Alternating inflation and deflation of the compression device improve venous return by simulating the calf pump mechanism.
  • Duration of prophylaxis in hospitalized patients [60]
Approach to VTE prophylaxis [60][61][62]
Indications Choice of prophylaxis [63][64]
Low-risk patients
At-risk outpatients
  • First-line: mechanical prophylaxis preferred; consider LMWH, e.g., enoxaparin as an alternative
  • Second-line: full-dose ASA [65]

Medical inpatients

  • Seriously ill or critically ill patients without high bleeding risk [66][67]
  • Seriously ill or critically ill medical patients with high bleeding risk

Surgical patients

Prophylaxis is usually indicated in seriously ill patients who are hospitalized, patients undergoing major surgery, patients with major trauma, and long-distance travelers with additional risk factors for VTE.

In surgical patients, the first dose of the antithrombotic should be administered within 12 hours of completing the surgery. [61]

LMWH or low-dose UFH is recommended for postoperative anticoagulation in patients who have undergone major surgery.

Complicationstoggle arrow icon

We list the most important complications. The selection is not exhaustive.

Acute management checklist for acute DVTtoggle arrow icon

Related One-Minute Telegram on DVTtoggle arrow icon

Interested in the newest medical research, distilled down to just one minute? Sign up for the One-Minute Telegram in “Tips and links” below.

Referencestoggle arrow icon

  1. Wells PS, Hirsh J, Anderson DR, et al. Accuracy of clinical assessment of deep-vein thrombosis.. Lancet (London, England). 1995; 345 (8961): p.1326-30.doi: 10.1016/s0140-6736(95)92535-x . | Open in Read by QxMD
  2. Wells PS, Anderson DR, Rodger M, et al. Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. N Engl J Med. 2003; 349 (13): p.1227-1235.doi: 10.1056/nejmoa023153 . | Open in Read by QxMD
  3. Engelberger RP et al.. Comparison of the diagnostic performance of the original and modified Wells score in inpatients and outpatients with suspected deep vein thrombosis. Thromb Res. 2011; 127 (6): p.535-539.doi: 10.1016/j.thromres.2011.02.008 . | Open in Read by QxMD
  4. Lim W et al.. American Society of Hematology 2018 guidelines for management of venous thromboembolism: diagnosis of venous thromboembolism. Blood Adv. 2018; 2 (22): p.3226-3256.doi: 10.1182/bloodadvances.2018024828 . | Open in Read by QxMD
  5. Cho HJ, Dunn AS. The Value of Using Ultrasound to Rule Out Deep Vein Thrombosis in Cases of Cellulitis. Journal of Hospital Medicine. 2017; 12 (4): p.259-261.doi: 10.12788/jhm.2719 . | Open in Read by QxMD
  6. Kearon C, Akl EA, Ornelas J, et al. Antithrombotic Therapy for VTE Disease. Chest. 2016; 149 (2): p.315-352.doi: 10.1016/j.chest.2015.11.026 . | Open in Read by QxMD
  7. Di Nisio et al.. Treatment for superficial thrombophlebitis of the leg. Cochrane Database Syst Rev. 2004.doi: 10.1002/14651858.cd004982 . | Open in Read by QxMD
  8. Perttu ET Arkkila. Thromboangiitis obliterans (Buerger's disease). Orphanet J Rare Dis. 2006; 1 (1).doi: 10.1186/1750-1172-1-14 . | Open in Read by QxMD
  9. Quéré I et al.. Superficial venous thrombosis and compression ultrasound imaging. J Vasc Surg. 2012; 56 (4): p.1032-1038.e1.doi: 10.1016/j.jvs.2012.03.014 . | Open in Read by QxMD
  10. Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.. Chest. 2012; 141 (2 Suppl): p.e419S-e496S.doi: 10.1378/chest.11-2301 . | Open in Read by QxMD
  11. Konkle BA. Superficial venous thrombosis: cause for concern. Blood. 2013; 122 (10): p.1691-1692.doi: 10.1182/blood-2013-07-514067 . | Open in Read by QxMD
  12. Sobreira ML, Maffei FH, Yoshida WB, et al. Prevalence of deep vein thrombosis and pulmonary embolism in superficial thrombophlebitis of the lower limbs: prospective study of 60 cases.. Int Angiol. 2009; 28 (5): p.400-8.
  13. Ellis MH, Fajer S. A current approach to superficial vein thrombosis.. Eur J Haematol. 2013; 90 (2): p.85-8.doi: 10.1111/ejh.12044 . | Open in Read by QxMD
  14. Scott G, Mahdi AJ, Alikhan R. Superficial vein thrombosis: a current approach to management. Br J Haematol. 2014; 168 (5): p.639-645.doi: 10.1111/bjh.13255 . | Open in Read by QxMD
  15. Beyer-Westendorf J, Schellong SM, Gerlach H, et al. Prevention of thromboembolic complications in patients with superficial-vein thrombosis given rivaroxaban or fondaparinux: the open-label, randomised, non-inferiority SURPRISE phase 3b trial. The Lancet Haematology. 2017; 4 (3): p.e105-e113.doi: 10.1016/s2352-3026(17)30014-5 . | Open in Read by QxMD
  16. Decousus H et al.. Fondaparinux for the Treatment of Superficial-Vein Thrombosis in the Legs. N Engl J Med. 2010; 363 (13): p.1222-1232.doi: 10.1056/nejmoa0912072 . | Open in Read by QxMD
  17. Piazza G, Goldhaber SZ. Acute pulmonary embolism: part I: epidemiology and diagnosis.. Circulation. 2006; 114 (2): p.e28-32.doi: 10.1161/CIRCULATIONAHA.106.620872 . | Open in Read by QxMD
  18. Ortel TL, Neumann I, Ageno W, et al. American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism. Blood Advances. 2020; 4 (19): p.4693-4738.doi: 10.1182/bloodadvances.2020001830 . | Open in Read by QxMD
  19. Prandoni P, Lensing AW, Cogo A, et al. The long-term clinical course of acute deep venous thrombosis.. Ann Intern Med. 1996; 125 (1): p.1-7.doi: 10.7326/0003-4819-125-1-199607010-00001 . | Open in Read by QxMD
  20. Al-Azzawi HF, Obi OC, Safi J, Song M. Nephrotic syndrome-induced thromboembolism in adults.. International journal of critical illness and injury science. ; 6 (2): p.85-8.doi: 10.4103/2229-5151.183019 . | Open in Read by QxMD
  21. Patel K. Deep Venous Thrombosis. Deep Venous Thrombosis. New York, NY: WebMD. Updated: March 30, 2016. Accessed: February 13, 2017.
  22. ENGBERS MJ, VAN HYLCKAMA VLIEG A, ROSENDAAL FR. Venous thrombosis in the elderly: incidence, risk factors and risk groups. J Thromb Haemost. 2010; 8 (10): p.2105-2112.doi: 10.1111/j.1538-7836.2010.03986.x . | Open in Read by QxMD
  23. Lip GYH, Hull RD. Overview of the treatment of lower extremity deep vein thrombosis (DVT). In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. Last updated: February 6, 2017. Accessed: February 13, 2017.
  24. Iliofemoral Deep Vein Thrombosis. Updated: October 24, 2015. Accessed: February 27, 2017.
  25. Branchford BR, Carpenter SL. The Role of Inflammation in Venous Thromboembolism. Frontiers in Pediatrics. 2018; 6.doi: 10.3389/fped.2018.00142 . | Open in Read by QxMD
  26. Thompson BT. Clinical presentation, evaluation, and diagnosis of the adult with suspected acute pulmonary embolism. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. Last updated: December 9, 2016. Accessed: February 14, 2017.
  27. Khan O, Marmaro A, Cohen DA. A review of upper extremity deep vein thrombosis. Postgrad Med. 2021; 133 (sup1): p.3-10.doi: 10.1080/00325481.2021.1892390 . | Open in Read by QxMD
  28. Engelberger RP, Kucher N. Management of Deep Vein Thrombosis of the Upper Extremity. Circulation. 2012; 126 (6): p.768-773.doi: 10.1161/circulationaha.111.051276 . | Open in Read by QxMD
  29. Mazzolai L, Aboyans V, Ageno W, et al. Diagnosis and management of acute deep vein thrombosis: a joint consensus document from the European Society of Cardiology working groups of aorta and peripheral vascular diseases and pulmonary circulation and right ventricular function. Eur Heart J. 2017; 39 (47): p.4208-4218.doi: 10.1093/eurheartj/ehx003 . | Open in Read by QxMD
  30. Bates SM, Jaeschke R, Stevens SM, et al. Diagnosis of DVT. Chest. 2012; 141 (2): p.e351S-e418S.doi: 10.1378/chest.11-2299 . | Open in Read by QxMD
  31. Needleman L, Cronan JJ, Lilly MP, et al. Ultrasound for Lower Extremity Deep Venous Thrombosis. Circulation. 2018; 137 (14): p.1505-1515.doi: 10.1161/circulationaha.117.030687 . | Open in Read by QxMD
  32. Patel H, Sun H, Hussain AN, Vakde T. Advances in the Diagnosis of Venous Thromboembolism: A Literature Review. Diagnostics. 2020; 10 (6): p.365.doi: 10.3390/diagnostics10060365 . | Open in Read by QxMD
  33. Schouten HJ, Koek HL, Oudega R, et al. Validation of two age dependent D-dimer cut-off values for exclusion of deep vein thrombosis in suspected elderly patients in primary care: retrospective, cross sectional, diagnostic analysis. BMJ. 2012; 344 (jun06 1): p.e2985-e2985.doi: 10.1136/bmj.e2985 . | Open in Read by QxMD
  34. Schouten HJ, Geersing GJ, Koek HL, et al. Diagnostic accuracy of conventional or age adjusted D-dimer cut-off values in older patients with suspected venous thromboembolism: systematic review and meta-analysis. BMJ. 2013; 346: p.f2492-f2492.doi: 10.1136/bmj.f2492 . | Open in Read by QxMD
  35. Ho VB et al.. ACR Appropriateness Criteria® on Suspected Lower Extremity Deep Vein Thrombosis. J Am Coll Radiol. 2011; 8 (6): p.383-387.doi: 10.1016/j.jacr.2011.02.016 . | Open in Read by QxMD
  36. Desjardins B, Hanley M, Steigner ML, et al. ACR Appropriateness Criteria® Suspected Upper Extremity Deep Vein Thrombosis. Journal of the American College of Radiology. 2020; 17 (5): p.S315-S322.doi: 10.1016/j.jacr.2020.01.020 . | Open in Read by QxMD
  37. Canty D, Mufti K, Bridgford L, Denault A. Point‐of‐care ultrasound for deep venous thrombosis of the lower limb. Australasian Journal of Ultrasound in Medicine. 2019; 23 (2): p.111-120.doi: 10.1002/ajum.12188 . | Open in Read by QxMD
  38. American College of Emergency Physicians. Emergency ultrasound imaging criteria compendium. Ann Emerg Med. 2006; 48 (4): p.487-510.doi: 10.1016/j.annemergmed.2006.07.946 . | Open in Read by QxMD
  39. Parakh RS, Sabath DE. Venous Thromboembolism: Role of the Clinical Laboratory in Diagnosis and Management.. The journal of applied laboratory medicine. 2019; 3 (5): p.870-882.doi: 10.1373/jalm.2017.025734 . | Open in Read by QxMD
  40. Van Es N, Le Gal G, Otten H-M, et al. Screening for Occult Cancer in Patients With Unprovoked Venous Thromboembolism. Ann Intern Med. 2017; 167 (6): p.410.doi: 10.7326/m17-0868 . | Open in Read by QxMD
  41. Carrier M, Lazo-Langner A, Shivakumar S, et al. Screening for Occult Cancer in Unprovoked Venous Thromboembolism. N Engl J Med. 2015; 373 (8): p.697-704.doi: 10.1056/nejmoa1506623 . | Open in Read by QxMD
  42. Sharifi M, Berger J, Beeston P, Bay C, Vajo Z, Javadpoor S. Pulseless electrical activity in pulmonary embolism treated with thrombolysis (from the “PEAPETT” study). Am J Emerg Med. 2016; 34 (10): p.1963-1967.doi: 10.1016/j.ajem.2016.06.094 . | Open in Read by QxMD
  43. Wilbur J, Shian B. Deep Venous Thrombosis and Pulmonary Embolism: Current Therapy.. Am Fam Physician. 2017; 95 (5): p.295-302.
  44. Konstantinides SV, Barco S, Lankeit M, Meyer G. Management of Pulmonary Embolism. J Am Coll Cardiol. 2016; 67 (8): p.976-990.doi: 10.1016/j.jacc.2015.11.061 . | Open in Read by QxMD
  45. Smythe MA, Priziola J, Dobesh PP, Wirth D, Cuker A, Wittkowsky AK. Guidance for the practical management of the heparin anticoagulants in the treatment of venous thromboembolism.. J Thromb Thrombolysis. 2016; 41 (1): p.165-86.doi: 10.1007/s11239-015-1315-2 . | Open in Read by QxMD
  46. van Es N, Coppens M, Schulman S, Middeldorp S, Büller HR. Direct oral anticoagulants compared with vitamin K antagonists for acute venous thromboembolism: evidence from phase 3 trials.. Blood. 2014; 124 (12): p.1968-75.doi: 10.1182/blood-2014-04-571232 . | Open in Read by QxMD
  47. Gómez-Outes A, Terleira-Fernández AI, Lecumberri R, Suárez-Gea ML, Vargas-Castrillón E. Direct oral anticoagulants in the treatment of acute venous thromboembolism: A systematic review and meta-analysis. Thromb Res. 2014; 134 (4): p.774-782.doi: 10.1016/j.thromres.2014.06.020 . | Open in Read by QxMD
  48. Wigle P, Hein B, Bloomfield HE, Tubb M, Doherty M. Updated guidelines on outpatient anticoagulation.. Am Fam Physician. 2013; 87 (8): p.556-66.
  49. Casey ET et al.. Treatment of acute iliofemoral deep vein thrombosis. J Vasc Surg. 2012; 55 (5): p.1463-1473.doi: 10.1016/j.jvs.2011.12.082 . | Open in Read by QxMD
  50. Bikdeli B et al.. Inferior Vena Cava Filters to Prevent Pulmonary Embolism. J Am Coll Cardiol. 2017; 70 (13): p.1587-1597.doi: 10.1016/j.jacc.2017.07.775 . | Open in Read by QxMD
  51. White RH, Brunson A, Romano PS, Li Z, Wun T. Outcomes After Vena Cava Filter Use in Noncancer Patients With Acute Venous Thromboembolism: A Population-Based Study.. Circulation. 2016; 133 (21): p.2018-29.doi: 10.1161/CIRCULATIONAHA.115.020338 . | Open in Read by QxMD
  52. Liu Z et al.. Bed Rest versus Early Ambulation with Standard Anticoagulation in The Management of Deep Vein Thrombosis: A Meta-Analysis. PLoS ONE. 2015; 10 (4): p.e0121388.doi: 10.1371/journal.pone.0121388 . | Open in Read by QxMD
  53. Meune C, Aissaoui N, et al. Is bed rest recommendation in the management of patients with pulmonary embolism and/or deep vein thrombosis evidence-based medicine: A meta-analysis. Circulation. 2018.
  54. Aissaoui N, Martins E, Mouly S, Weber S, Meune C. A meta-analysis of bed rest versus early ambulation in the management of pulmonary embolism, deep vein thrombosis, or both.. Int J Cardiol. 2009; 137 (1): p.37-41.doi: 10.1016/j.ijcard.2008.06.020 . | Open in Read by QxMD
  55. Risser A, Donovan D, Heintzman J, Page T. NSAID prescribing precautions.. Am Fam Physician. 2009; 80 (12): p.1371-8.
  56. Barrett TW, Wrenn KD, Slovis CM, et al. An Outpatient Management Protocol for Emergency Department Patients With a Newly Diagnosed Lower Extremity Deep Venous Thrombosis. Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine. 2016; 15 (3): p.75-76.doi: 10.1097/hpc.0000000000000089 . | Open in Read by QxMD
  57. Musani MH, Musani MA, Verardi MA. Venous Gangrene a Rare but Dreadful Complication of Deep Venous Thrombosis. Clinical and Applied Thrombosis/Hemostasis. 2010; 17 (6): p.E1-E3.doi: 10.1177/1076029610376629 . | Open in Read by QxMD
  58. Schünemann HJ, Cushman M, Burnett AE, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: prophylaxis for hospitalized and nonhospitalized medical patients. Blood Advances. 2018; 2 (22): p.3198-3225.doi: 10.1182/bloodadvances.2018022954 . | Open in Read by QxMD
  59. Anderson DR et al.. American Society of Hematology 2019 guidelines for management of venous thromboembolism: prevention of venous thromboembolism in surgical hospitalized patients. Blood Adv. 2019; 3 (23): p.3898-3944.doi: 10.1182/bloodadvances.2019000975 . | Open in Read by QxMD
  60. Kahn SR, Lim W, Dunn AS, et al. Prevention of VTE in Nonsurgical Patients. Chest. 2012; 141 (2): p.e195S-e226S.doi: 10.1378/chest.11-2296 . | Open in Read by QxMD
  61. Laryea J, Champagne B. Venous thromboembolism prophylaxis.. Clinics in colon and rectal surgery. 2013; 26 (3): p.153-9.doi: 10.1055/s-0033-1351130 . | Open in Read by QxMD
  62. Chen A, Stecker E, A. Warden B. Direct Oral Anticoagulant Use: A Practical Guide to Common Clinical Challenges. Journal of the American Heart Association. 2020; 9 (13).doi: 10.1161/jaha.120.017559 . | Open in Read by QxMD
  63. Cesarone MR, Belcaro G, Nicolaides AN, et al. Venous thrombosis from air travel: the LONFLIT3 study--prevention with aspirin vs low-molecular-weight heparin (LMWH) in high-risk subjects: a randomized trial.. Angiology. ; 53 (1): p.1-6.doi: 10.1177/000331970205300101 . | Open in Read by QxMD
  64. William H. Geerts, Graham F. Pineo, John A. Heit, David Bergqvist, Michael R. Lassen, Clifford W. Colwell, Joel G. Ray. Prevention of Venous Thromboembolism. Chest. 2004; 126 (3): p.338S-400S.doi: 10.1378/chest.126.3_suppl.338s . | Open in Read by QxMD
  65. Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2019; 50 (12).doi: 10.1161/str.0000000000000211 . | Open in Read by QxMD
  66. Mandernach MW, Beyth RJ, Rajasekhar A. Apixaban for the prophylaxis and treatment of deep vein thrombosis and pulmonary embolism: an evidence-based review.. Therapeutics and clinical risk management. 2015; 11: p.1273-82.doi: 10.2147/TCRM.S68010 . | Open in Read by QxMD
  67. Kirkilesis G, Kakkos SK, Bicknell C, Salim S, Kakavia K. Treatment of distal deep vein thrombosis. Cochrane Database of Systematic Reviews. 2020.doi: 10.1002/14651858.cd013422.pub2 . | Open in Read by QxMD
  68. Galioto NJ, Danley DL, Van Maanen RJ. Recurrent venous thromboembolism.. Am Fam Physician. 2011; 83 (3): p.293-300.
  69. Ageno W, Squizzato A, Wells PS, Büller HR, Johnson G. The diagnosis of symptomatic recurrent pulmonary embolism and deep vein thrombosis: guidance from the SSC of the ISTH. Journal of Thrombosis and Haemostasis. 2013; 11 (8): p.1597-1602.doi: 10.1111/jth.12301 . | Open in Read by QxMD
  70. Agabegi SS, Agabegi ED. Step-Up To Medicine. Lippincott Williams & Wilkins ; 2013
  71. Peters M, Syed RK, Katz M, et al. May-Thurner syndrome: a not so uncommon cause of a common condition. Proc (Bayl Univ Med Cent). 2012; 25 (3): p.231-233.
  72. Kearon C, Bauer KA, Leung LLK, Mandel J, Finlay G. Clinical Presentation and Diagnosis of the Nonpregnant Adult With Suspected Deep Vein Thrombosis of the Lower Extremity. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. Last updated: March 24, 2017. Accessed: October 6, 2017.
  73. Deep Vein Thrombosis. . Accessed: October 6, 2017.
  74. Mumoli N, Invernizzi C, Luschi R, Carmignani G, Camaiti A, Cei M. Phlegmasia cerulea dolens. Circulation. 2012; 125 (8): p.1056-1057.doi: 10.1161/circulationaha.111.051912 . | Open in Read by QxMD
  75. Mall NA, Van Thiel GS, Heard WM, Paletta GA, Bush-Joseph C, Bach BR. Paget-Schroetter Syndrome. Sports Health. 2013; 5 (4): p.353-356.doi: 10.1177/1941738112470911 . | Open in Read by QxMD
  76. Wells PS, Anderson DR, Bormanis J, et al. Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Lancet. 1997; 350 (9094): p.1795-1798.doi: 10.1016/s0140-6736(97)08140-3 . | Open in Read by QxMD
  77. Liepman CI, Koerber JM, Mattson JC, Westley SJ, Smythe MA. Comparing methods of establishing the aPTT therapeutic range of heparin. Ann Pharmacother. 2003; 37 (6): p.794-798.doi: 10.1345/aph.1c162 . | Open in Read by QxMD
  78. Guyatt GH, Akl EA, Crowther M, Gutterman DD, Schuünemann HJ. Antithrombotic therapy and prevention of thrombosis - 9th. Chest. 2012; 141 (2): p.7S-47S.doi: 10.1378/chest.1412s3 . | Open in Read by QxMD
  79. Superficial Vein Thrombosis (SVT). Updated: August 10, 2018. Accessed: May 14, 2019.
  80. Birn J, Vedantham S. May–Thurner syndrome and other obstructive iliac vein lesions: Meaning, myth, and mystery. Vascular Medicine. 2014; 20 (1): p.74-83.doi: 10.1177/1358863x14560429 . | Open in Read by QxMD
  81. Parry BA et al.. International, multicenter evaluation of a new D-dimer assay for the exclusion of venous thromboembolism using standard and age-adjusted cut-offs. Thromb Res. 2018; 166: p.63-70.doi: 10.1016/j.thromres.2018.04.003 . | Open in Read by QxMD
  82. Matharu GS et al.. Clinical Effectiveness and Safety of Aspirin for Venous Thromboembolism Prophylaxis After Total Hip and Knee Replacement. JAMA. 2020; 180 (3): p.376.doi: 10.1001/jamainternmed.2019.6108 . | Open in Read by QxMD

Icon of a lock3 free articles remaining

You have 3 free member-only articles left this month. Sign up and get unlimited access.
 Evidence-based content, created and peer-reviewed by physicians. Read the disclaimer