Stevens et al made recommendations for antithrombotic therapy in patients with venous thromboembolism. One subgroup of patients are those with distal deep vein thrombosis. The authors are from multiple institutions from the United States, Canada, and Europe.
Patient selection: distal deep vein thrombosis (DVT)
Indications for anticoagulation:
(1) D-dimer positive without alternative reason, especially if high
(2) thrombosis is extensive (> 5 cm in length; > 7 mm in maximum diameter; in multiple veins)
(3) thrombosis is close to a proximal vein
(4) no reversible triggering factor for the thrombosis
(5) active cancer
(6) history of venous thromboembolism
(7) inpatient
(8) has COVID-19
(9) highly symptomatic
(10) patient prefers to avoid serial imaging
Indications to follow with serial imaging for 2 weeks:
(1) thrombosis is confined to muscular veins of the calf
(2) moderate to high risk of bleeding if anticoagulated
(3) patient prefers to avoid anticoagulation
In patients being monitored by serial imaging, anticoagulation is started if the distal thrombi propagate.
