Why the study?
Although multiple international societies have published evidence-based clinical practice guidelines for acute deep vein thrombosis, important differences persist across guidance.
This comparative review highlights substantial international consensus on core DVT management principles, clarifying that remaining guideline discrepancies largely stem from publication timing, methodological variations, and healthcare contexts rather than fundamentally conflicting evidence.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“The authors present a timely and comprehensive narrative review comparing contemporary international clinical practice guidelines for the diagnosis and management of acute deep vein thrombosis (DVT). The topic is highly relevant, given the increasing number of available guidelines and the persistent heterogeneity in several aspects of DVT management. The manuscript is well organized, clearly written, and provides a useful comparison of recommendations across major international societies.”
“This manuscript addresses a clinically relevant topic by comparing international recommendations for the diagnosis and management of acute deep vein thrombosis. The broad coverage of diagnostic pathways, anticoagulant selection, treatment duration, isolated distal DVT, compression therapy, endovascular interventions, special populations, and pediatric DVT is potentially useful. However, the manuscript currently has important methodological, factual-consistency, structural, and editorial problems that should be resolved before publication.”
“I think the “Second consensus document on diagnosis and management of acute deep vein thrombosis”, an ESC document, should be taken into account. I think a compression ultrasound should be performed in the whole legs, bilaterally, in all patients with clinically suspected DVT. It is a quick examination, and ultrasound is a well-established, well-known and quick technique.”
May guide consistent DOAC-first care in acute DVT; leaves open distal disease and duration strategies until randomized trials resolve divergences.
Acute deep vein thrombosis (DVT) continues to represent a significant global contributor to morbidity and mortality. Although multiple international societies have published evidence-based clinical practice guidelines, important differences persist. This structured narrative review compares contemporary international guidance to identify areas of consensus, methodological divergence, evidence gaps, and priorities for future research. Recommendations were compared across diagnostic evaluation, anticoagulant selection, treatment duration, outpatient management, compression therapy, endovascular intervention, and special populations. Broad agreement was identified regarding clinical pretest probability assessment, D-dimer testing, compression ultrasonography, and direct oral anticoagulants as first-line therapy for most eligible patients with acute DVT. Clinically important differences remain, however, in the management of isolated distal DVT, anticoagulation duration, catheter-directed interventions, compression therapy, and selected high-risk populations. These discrepancies primarily reflect differences in publication timing, methodological frameworks, interpretation of emerging evidence, and healthcare-system context rather than fundamentally conflicting evidence. Contemporary international guidance therefore demonstrates substantial convergence on the core principles of acute DVT management while continuing to differ in areas supported by limited or evolving evidence. Future harmonization will require high-quality randomized trials, broader international collaboration, and the integration of precision medicine, validated risk-prediction models, biomarkers, and emerging anticoagulant strategies into guideline development.
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Gonzalez-Ochoa et al. (2026) conducted a review in Acute deep vein thrombosis (DVT). International clinical practice guidelines for acute DVT was evaluated. Contemporary international guidelines show broad agreement on core principles of acute DVT management, including DOACs as first-line therapy, but differ in areas with limited or evolving evidence.
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