Vol 1, No 2 (2010)
Review paper
Published online: 2010-05-14

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Initial treatment and secondary prophylaxis of deep vein thrombosis

Jerzy Windyga
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.

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Hematology in Clinical Practice