Whom to treat-venous thromboembolism

(JAMA 2020;324:1765; Chest 2021;160:e545)

• Superficial venous thrombosis:

  • elevate extremity, warm compresses, compression stockings, NSAIDs for sx. Anticoag if high risk for DVT (eg, ≥5 cm, proximity to deep vein ≤5 cm, other risk factors) for 4 wk as ~10% have VTE w/in 3 mo (Annals 2010;152:218).

• LE DVT:

  • proximal → anticoag; distal → anticoag if severe sx, o/w consider serial imaging over 2 wk and anticoag if extends (although if bleeding risk low, many would anticoag).

• UE DVT:

  • anticoagulate (same guidelines as LE; NEJM 2011;364:861). If catheter-associated, need not remove if catheter functional and ongoing need for catheter.

• PE:

  • anticoagulate (unless isolated subsegmental and risk for recurrent VTE low)