Clinical Practice Recommendations for the Management of Lower Limb Deep Vein Thrombosis in India

Bacground: Deep vein thrombosis (DVT), a major manifestation of venous thromboembolism, is a preventable cause of morbidity and mortality but remains underdiagnosed in India. To address this gap, a 13-member expert panel reviewed existing evidence and international guidelines to formulate clinical practice recommendations tailored for the Indian context. Methods: The methodology included systematic literature review and expert consensus developed during dedicated meeting on management of DVT and Deep Venous procedures. The recommendations cover the entire spectrum of DVT care: diagnosis, patient selection, treatment, intervention, post-operative management, and thrombophilia screening. Results: Duplex ultrasound is endorsed as the primary diagnostic tool, while CT venography, MR venography, and intravascular ultrasound (IVUS) are recommended in selected situations. For treatment, anticoagulation remains the cornerstone, but catheter-directed thrombolysis, pharmacomechanical thrombectomy, and venous stenting are advocated in appropriate patients, especially those with iliofemoral involvement, threatened limb, or May–Thurner syndrome. Emphasis is placed on IVUS-guided stenting for accurate lesion assessment and optimal outcomes. Post-intervention, low-molecular-weight heparin followed by direct oral anticoagulants is preferred, with structured follow-up protocols using duplex ultrasound. Thrombophilia testing is advised only in select populations where results may influence long-term management. Conclusions: By integrating these evidence-based and consensus-driven recommendations into practice, healthcare providers can standardize DVT management in India, improve patient outcomes, reduce the incidence of post-thrombotic syndrome, and minimize recurrence while balancing procedural risks.