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Office Management of Deep Venous Thrombosis in the Elderly
American Journal of Medicine, 09/29/09

Jacobs LG et al. – As signs and symptoms are inconsistent and nonspecific, diagnostic testing is necessary. For patients with a low clinical probability, a normal D–dimer result can rule out disease. For patients with a high clinical suspicion or an elevated D–dimer, duplex ultrasonography may confirm the diagnosis. Anticoagulation, usually with low–molecular–weight heparin, should begin on suspicion and continue, along with warfarin, until the international normalized ratio is therapeutic. Arrangements for the initial daily injections can be made with a visiting nurse. Treatment should continue for at least 3 months, when a risk–versus–benefit analysis for continuing anticoagulation should be undertaken. Therapy may be discontinued for thromboses associated with a reversible risk factor or for patients in whom anticoagulant management was unstable or complicated by bleeding. A persistently high D–dimer result or evidence of residual clot on repeat duplex ultrasonography may support continuation. For all patients, the use of compression stockings to prevent the post–thrombotic syndrome is recommended.

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