Venous Thromboembolism General Management

Venous thromboembolism management requires accurate diagnosis followed by appropriate anticoagulation. Initial therapy uses parenteral heparin or direct oral anticoagulant for at least three months. Treatment duration depends on whether VTE was provoked or unprovoked and ongoing risk factors. Selection of anticoagulant considers comorbidities renal function and bleeding risk.

Direct oral anticoagulants apixaban rivaroxaban edoxaban and dabigatran are first line for most VTE except severe renal impairment cancer associated thrombosis with luminal cancers and antiphospholipid syndrome where vitamin K antagonist or low molecular weight heparin remain preferred. Provoked VTE typically requires three months of treatment while unprovoked VTE may benefit from extended therapy.

Long term management includes assessing recurrence risk with clinical decision tools like HERDOO2 or Vienna prediction model bleeding risk evaluation and shared decision making about extended anticoagulation. Compression stockings reduce post thrombotic syndrome severity. IVC filters are reserved for absolute contraindication to anticoagulation. Regular follow up monitors symptoms recurrence and bleeding.