Managing DVT and PE

Alongside their use for the treatment of DVT / PE and prevention of recurrent DVT / PE, anticoagulants can also be used to reduce the risk of secondary complications such as post-thrombotic syndrome (PTS) and chronic thromboembolic pulmonary hypertension (CTEPH).1,2

The phases of anticoagulation treatment may be categorised as initial, long-term (or continued) and extended.3

Phases of anticoagulation treatment for DVT and PE4–9

Adapted from Kearon et al. Thromb Haemost 2012.4
* Heparin, low molecular weight heparin (LMWH), fondaparinux. Initial therapy may be with oral apixaban for 7 days or rivaroxaban for 21 days.
† Includes LMWH and non-vitamin K antagonist oral anticoagulants (NOACs).

Guidelines for managing VTE

“In the absence of contraindications, [NOACs] should be preferred as first-line anticoagulant therapy in non-cancer patients with proximal DVT.”3
– ESC Consensus Statement, 2018

“When oral anticoagulation is initiated in a patient with PE who is eligible for a NOAC (apixaban, dabigatran, edoxaban or rivaroxaban), a NOAC is the recommended form of anticoagulant treatment.”10
– ESC Guidelines, 2019

“In patients with DVT of the leg or PE and no cancer, as long-term (first 3 months) anticoagulant therapy, we suggest dabigatran, rivaroxaban, apixaban, or edoxaban over VKA therapy.”11
– ACCP Guidelines, 2016

More information on anticoagulants for the treatment and secondary prevention of VTE is provided later in the long-term prevention page.

Abbreviations

  • ACCP = American College of Chest Physicians
  • CTEPH = Chronic Thromboembolic Pulmonary Hypertension
  • DVT = Deep Vein Thrombosis
  • ESC = European Society of Cardiology
  • LMWH = Low Molecular Weight Heparin
  • NOAC = Non-vitamin K antagonist Oral Anticoagulant
  • PE = Pulmonary Embolism
  • PTS = Post-Thrombotic Syndrome
  • VKA = Vitamin K Antagonist
  • VTE = Venous Thromboembolic Events

  1. Lang IM, Madani M. Update on chronic thromboembolic pulmonary hypertension. Circulation 2014;130:508–18. https://doi.org/10.1161/CIRCULATIONAHA.114.009309; PMID: 25092279.
  2. Farrell JJ, Sutter C, Tavri S, Patel I. Incidence and interventions for post-thrombotic syndrome. Cardiovasc Diagn Ther 2016;6:623–31. https://doi.org/10.21037/cdt.2016.11.22; PMID: 28123982.
  3. 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 2018;39:4208–18. https://doi.org/10.1093/eurheartj/ehx003; PMID: 28329262.
  4. Kearon C. A conceptual framework for two phases of anticoagulant treatment of venous thromboembolism. J Thromb Haemost 2012;10:507–11. https://doi.org/10.1111/j.1538-7836.2012.04629.x; PMID: 22497864.
  5. 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): e419S–e496S. https://doi.org/10.1378/chest.11-2301; PMID: 22314268.
  6. Apixaban Summary of Product Characteristics.
  7. Dabigatran Summary of Product Characteristics.
  8. Edoxaban Summary of Product Characteristics.
  9. Rivaroxaban Summary of Product Characteristics.
  10. Konstantinides S, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society: The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology. Eur Heart J 2019;00:1–61. https://doi.org/10.1093/eurheartj/ehz405; PMID: 31473594.
  11. Kearon C, Akl EA, Ornelas J, et al. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest 2016;149;315–52. https://doi.org/10.1016/j.chest.2015.11.026; PMID: 26867832.

December 2019
PP-ELI-GBR-6093