Management of deep vein thrombosis and prevention of post-thrombotic syndrome

#### Summary points The annual global incidence of deep vein thrombosis (DVT) of the leg is 1.6 per 1000.1 Classically, venous thrombosis of a lower limb begins in a deep calf vein and propagates more proximally. Symptoms include swelling, pain, and redness of the leg, depending on the vein segment(s) involved (see table 1⇓).2 Patients are at risk of pulmonary embolism.3 Despite optimal conservative treatment with anticoagulation and compression, one in four patients develops a post-thrombotic syndrome within one year,2 and one in three develops a recurrent DVT within five years.4 Patients with post-thrombotic syndrome have poor quality of life.5 A more aggressive approach to treatment, such as removal of early thrombus using catheter directed thrombolysis, might improve outcomes for patients with DVT compared with standard anticoagulation treatment.4 5 6 7 8 9 10 11 12 We review standard and new, more aggressive, management of DVT for the generalist reader, drawing from recent guidelines, cohort studies, small randomised controlled trails, and meta-analyses. All authors are investigators in the CAVA trial, which is one of three randomised controlled trials currently investigating outcomes after treatment with catheter …