Vol 1, No 2 (2010)
Review paper
Published online: 2010-05-14
Initial treatment and secondary prophylaxis of deep vein thrombosis
Hematologia 2010;1(2):119-125.
Abstract
The main objectives of the initial treatment of acute deep vein thrombosis are to stop clot
propagation and prevent potentially fatal pulmonary embolism. These goals are usually
achieved with anticoagulation using: 1) low-molecular-weight heparin or 2) unfractionated
heparin or 3) fondaparinux. The role of thrombolytic therapy and surgical
thrombectomy as well as the indications for insertion of an inferior vena cava filter in
patients with acute deep vein thrombosis are limited. After a 5-10-day period of the
initial treatment, continuing anticoagulant therapy (secondary thromboprophylaxis) is required for prevention of recurrent venous thromboembolic events and post-thrombotic syndrome.
The duration of secondary thromboprophylaxis is variable and depends on numerous
factors but usually ranges from 3 to 12 months. Coumarin derivatives or vitamin K antagonists
have been the preferred agents used for secondary prophylaxis of venous thromboembolism
since many years. Antiplatelet agents such as acetylsalicylic acid or thienopyridines (that
selectively inhibit adenosine diphosphate-induced platelet aggregation) should not be used in
the prevention or treatment of deep vein thrombosis.
Keywords: deep vein thrombosisinitial treatmentsecondary prophylaxisheparinoral anticoagulantfondaparinuxthrombolytics