Initial and long-term treatment of deep venous thrombosis: recent clinical trials and their impact on patient management

INTRODUCTION: Deep venous thrombosis (DVT) is common and associated with significant morbidity and mortality if not diagnosed early and managed effectively. Specific conditions including advanced age, obesity and renal impairment need to be considered when implementing anticoagulation treatment to ensure optimal therapeutic efficacy and safety. AREAS COVERED: This review summarizes the current treatment of acute DVT according to the 2012 American College of Physicians Evidence-based Clinical Practice Guidelines. Recent and ongoing clinical trials on acute DVT treatment are highlighted. The authors also provide suggestion for the treatment of DVT in patients with advanced age, obesity and renal impairment. EXPERT OPINION: New oral anticoagulants (NOACs) have the potential as an alternative to warfarin for DVT treatment. Elastic compressive stockings and catheter-directed thrombolysis should be considered for symptomatic relief and the prevention of post-thrombotic syndrome, respectively. ASA has emerged as a treatment option for selected patients with unprovoked DVT and pulmonary embolism (PE) with a low-to-intermediate risk for disease recurrence or who are unsuitable for long-term oral anticoagulant therapy due to practical or safety reasons. Additional trials are needed in special patient populations, including the elderly, obese and those with renal impairment and cancer-associated DVT, to assess the efficacy and safety of anticoagulants especially the NOACs for DVT treatment.