Treatment for<unk>  is warranted when the clots are either proximal, distal and symptomatic, or upper extremity and symptomatic. Providing anticoagulation, or blood-thinning medicine, is the typical treatment after patients are checked to make sure they are not subject to bleeding. However, treatment varies depending upon the location of<unk> . For example, in cases of isolated distal<unk> , ultrasound surveillance (a second ultrasound after 2 weeks to check for proximal clots), might be used instead of anticoagulation. Although, those with isolated distal<unk>  at a high-risk of VTE recurrence are typically anticoagulated as if they had proximal<unk> . Those at a low-risk for recurrence might receive a four to six week course of anticoagulation, lower doses, or no anticoagulation at all. In contrast, those with proximal<unk>  should receive at least 3 months of anticoagulation. Some anticoagulants can be taken by mouth, and these oral medicines include warfarin (a vitamin K antagonist), rivaroxaban (a factor Xa inhibitor), apixaban (a factor Xa inhibitor), dabigatran (a direct thrombin inhibitor), and edoxaban (a factor Xa inhibitor). Other anticoagulants cannot be taken by mouth. These parenteral (non-oral) medicines include low-molecular-weight heparin, fondaparinux, and unfractionated heparin. Some oral medicines are sufficient when taken alone, while others require the use of an additional parenteral blood thinner. Rivaroxaban and apixaban are the typical first-line medicines, and they are sufficient when taken orally. Rivaroxaban is taken once daily, and apixaban is taken twice daily. Warfarin, dabigatran, and edoxaban require the use of a parenteral anticoagulant to initiate oral anticoagulant therapy. When warfarin is initiated for VTE treatment, a 5-day minimum of a parenteral anticoagulant together with warfarin is given, which is followed by warfarin-only therapy. Warfarin is taken to maintain an international normalized ratio (INR) of 2.0–3.0, with 2.5 as the target. The benefit of taking warfarin declines as the duration of treatment extends, and the risk of bleeding increases with age. Periodic INR monitoring is not necessary when first-line direct oral anticoagulants are used. Overall, anticoagulation therapy is complex and many circumstances can affect how these therapies are managed. The duration of anticoagulation therapy (whether it will last 4 to 6 weeks, 6 to 12 weeks, 3 to 6 months, or indefinitely) is a key factor in clinical decision making. When proximal<unk>  is provoked by surgery or trauma a 3-month course of anticoagulation is standard. When a first VTE is proximal<unk>  that is either unprovoked or associated with transient non-surgical risk factor, low-dose anticoagulation beyond 3 to 6 months might be used. In those with an annual risk of VTE in excess of 9%, as after an unprovoked episode, extended anticoagulation is a possibility. Those who finish warfarin treatment after idiopathic VTE with an elevated D-dimer level show an increased risk of recurrent VTE (about 9% vs about 4% for normal results), and this result might be used in clinical decision making. Thrombophilia test results rarely play a role in the length of treatment. Treatment for acute leg<unk>  is suggested to continue at home for uncomplicated<unk>  instead of hospitalization. Factors that favor hospitalization include severe symptoms or additional medical issues. Early walking is suggested over bedrest. Graduated compression stockings—which apply higher pressure at the ankles and a lower pressure around the knees can be trialed for symptomatic management of acute<unk>  symptoms, but they are not recommended for reducing the risk of post-thrombotic syndrome, as the potential benefit of using them for this goal "may be uncertain". Nor are compression stockings likely to reduce VTE recurrence. They are, however, recommended in those with isolated distal<unk> . If someone decides to stop anticoagulation after an unprovoked VTE instead of being on lifelong anticoagulation, aspirin can be used to reduce the risk of recurrence, but it is only about 33% as effective as anticoagulation in preventing recurrent VTE. Statins have also been investigated for their potential to reduce recurrent VTE rates, with some studies suggesting effectiveness. Investigations for cancer An unprovoked VTE might signal the presence of an unknown cancer, as it is an underlying condition in up to 10% of unprovoked cases. A thorough clinical assessment is needed and should include a physical examination, a review of medical history, and universal cancer screening done in people of that age. A review of prior imaging is considered worthwhile, as is "reviewing baseline blood test results including full blood count, renal and hepatic function, PT and APTT." It is not recommended practice to obtain tumor markers or a CT of the abdomen and pelvis in asymptomatic individuals. NICE recommends that further investigations are unwarranted in those without relevant signs or symptoms. Interventions Thrombolysis is the injection of an enzyme into the veins to dissolve blood clots, and while this treatment has been proven effective against the life-threatening emergency clots of stroke and heart attacks, randomized controlled trials have not established a net benefit in those with acute proximal<unk> . Drawbacks of catheter-directed thrombolysis (the preferred method of administering the clot-busting enzyme) include a risk of bleeding, complexity, and the cost of the procedure. Although, while anticoagulation is the preferred treatment for<unk> , thrombolysis is a treatment option for those with the severe<unk>  form of phlegmasia cerula dorens (bottom left image) and in some younger patients with<unk>  affecting the iliac and common femoral veins. Of note, a variety of contraindications to thrombolysis exist. In 2020, NICE kept their 2012 recommendations that catheter-directed thrombolysis should be considered in those with iliofemoral<unk>  who have "symptoms lasting less than 14 days, good functional status, a life expectancy of 1 year or more, and a low risk of bleeding." A mechanical thrombectomy device can remove<unk>  clots, particularly in acute iliofemoral<unk>  <unk>  of the major veins in the pelvis), but there is limited data on its efficacy. It is usually combined with thrombolysis, and sometimes temporary IVC filters are placed to protect against PE during the procedure. Catheter-directed thrombolysis with thrombectomy against iliofemoral<unk>  has been associated with a reduction in the severity of post-thrombotic syndrome at an estimated cost-effectiveness ratio of about $138,000 per gained QALY. Phlegmasia cerulea dolens might be treated with catheter-directed thrombolysis and/or thrombectomy. In<unk>  in the arm, the first (topmost) rib can be surgically removed as part of the typical treatment when the<unk>  is due to thoracic outlet syndrome or Paget–Schroetter syndrome. This treatment involves initial anticoagulation followed by thrombolysis of the subclavian vein and staged first rib resection to relieve the thoracic outlet compression and prevent recurrent<unk> . File:Gray966.The first rib, which is removed in a first rib resection surgery, is labeled 1 in this image File:A-case-of-Paget-Schroetter-syndrome-(PSS)-in-a-young-judo-tutor-a-case-report-13256 2016 848 Fig1 HTML.A venogram before catheter-directed thrombolysis for Paget–Schroetter syndrome, a rare and severe arm<unk>  shown here in a judo practitioner, with highly restricted blood flow shown in the vein File:A-case-of-Paget-Schroetter-syndrome-(PSS)-in-a-young-judo-tutor-a-case-report-13256 2016 848 Fig2 HTML.After treatment with catheter-directed thrombolysis, blood flow in the axillary and subclavian vein were significantly improved. Afterwards, a first rib resection allowed decompression. This reduces the risk of recurrent<unk>  and other sequelae from thoracic outlet compression. An IVC filter The placement of an inferior vena cava filter (IVC filter) is possible when either the standard treatment for acute<unk> , anticoagulation, is absolutely contraindicated (not possible), or if someone develops a PE despite being anticoagulated. However, a 2020 NICE review found "little good evidence" for their use. A 2018 study associated IVC filter placement with a 50% reduction in PE, a 70% increase in<unk> , and an 18% increase in 30 day mortality when compared to no IVC placement. Other studies including a systematic review and meta-analysis did not find a difference in mortality with IVC placement. If someone develops a PE despite being anticoagulated, care should be given to optimize anticoagulation treatment and address other related concerns before considering IVC filter placement. Field of medicine Patients with a history of<unk>  might be managed by primary care, general internal medicine, hematology, cardiology, vascular surgery, or vascular medicine. Patients suspected of having an acute<unk>  are often referred to the emergency department for evaluation. Interventional radiology is the specialty that typically places and retrieves IVC filters, and vascular surgery might do catheter directed thrombosis for some severe<unk> s.
Deep vein thrombosis
Hematoma
Varicose veins
Cellulitis
Superficial vein thrombosis
Lymphedema
Venous thrombosis
Baker's cyst