Management of Venous Thromboembolism: Treatment of Deep Vein Thrombosis and Pulmonary Embolism

Patient Guideline Summary

Publication Date: October 2, 2020

Last Updated: March 3, 2023

Objective

This patient summary means to discuss key recommendations from the American Society of Hematology (ASH) for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism. It is limited to adults 18 years of age and older and should not be used as a reference for children.

Overview

Venous thromboembolism (VTE) describes blood clots forming in veins and traveling, usually into the lungs.
We will use the abbreviation DVT throughout this summary to refer to deep venous thrombosis and PE to refer to pulmonary embolism.
There are two conditions in view here.
- DVT: blood clots in veins, most commonly in a leg. Severe cases threaten blood circulation in the affected limb.
- Embolism: – the movement of a clot, usually into a lung. Large or multiple emboli can be life-threatening.
Some of the most common causes of VTE are cancer, trauma, heart conditions, paralysis, and extended time sitting, as in an airplane.
Symptoms of DVT include pain, swelling, warmth, and discoloration of the affected limb.
Symptoms of PE include difficulty breathing, chest discomfort, heart pounding, faintness, and coughing up blood.
This patient summary focuses on the management of venous thromboembolism.

Diagnosis

Ultrasound, prognostic scoring systems, and D-dimer blood testing are generally not helpful for diagnosis but may help decide on the duration of treatment.

Treatment

All treatment decisions are based on the individual circumstances of each patient.

Uncomplicated DVT and PE can be managed at home. More severe cases or otherwise unhealthy patients may require hospitalization.
Medical treatment entails preventing the extension of the clot or dissolving the clot, or both.
- Thrombolysis (clot-dissolving) can be accomplished by giving certain drugs intravenously or through a catheter directly into a clot.
- Anticoagulation prevents further clotting by “thinning” the blood. There are several classes of anticoagulants.
  - Intravenous low molecular weight heparin
  - Oral agents:
    - Vitamin K antagonists (blockers)
    - Aspirin
    - Rivaroxaban, apixaban, edoxaban and dabigatran
Surgical treatments:
- Open removal of clots
- Catheter placement of a filter above the clot to prevent it from moving into the lungs
Compression stockings help prevent blood from pooling in the legs.

Note: DVT often destroys the valves in veins that reduce venous pressure in the legs. Compression stockings direct blood through other channels.

Follow-up

Duration of medical treatment is an individual decision weighing the severity of the condition, the risk of continued medication, and the general health of each patient.

Abbreviations

ASH: American Society Of Hematology
DVT: Deep Venous Thrombosis
PE: Pulmonary Embolism
VTE: Venous Thromboembolism

Source Citation

Thomas L. Ortel, Ignacio Neumann, Walter Ageno, Rebecca Beyth, Nathan P. Clark, Adam Cuker, Barbara A. Hutten, Michael R. Jaff, Veena Manja, Sam Schulman, Caitlin Thurston, Suresh Vedantham, Peter Verhamme, Daniel M. Witt, Ivan D. Florez, Ariel Izcovich, Robby Nieuwlaat, Stephanie Ross, Holger J. Schünemann, Wojtek Wiercioch, Yuan Zhang, Yuqing Zhang; American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism. Blood Adv. 2020; 4 (19): 4693–4738. doi: https://doi.org/10.1182/bloodadvances.2020001830

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.