| Deep vein thrombosis (DVT) |
LMWH for acute and chronic therapy UFH, LMWH or Fondaparinux with transition over 5–7 days to Warfarin (INR 2–3) is an acceptable alternative if LMWH not feasible Duration at least 3 months or for as long as cancer active (whichever is longer) For massive DVT, consider catheter-directed pharmacomechanical thrombolysis If anticoagulation contraindicated, consider retrievable vs. permanent vena cava filter
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| Pulmonary embolism |
LMWH for acute and chronic therapy UFH, LMWH or Fondaparinux with transition over 5–7 days to Warfarin (INR 2–3) is an acceptable alternative if LMWH not feasible Duration at least 6 months or for as long as cancer active (whichever is longer) For massive PE, consider thrombolytic therapy If anticoagulation contraindicated, consider retrievable vs. permanent vena cava filter
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| CVC-related DVT |
Initial therapy with UFH, LMWH or Fondaparinux with transition over 5–7 days to Warfarin (INR 2–3) Remove catheter if symptoms fail to improve or catheter no longer needed Duration at least 3 months or for as long as catheter is present (whichever is longer) For massive CVC-related DVT consider thrombolytic therapy
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| Superficial venous thrombosis |
If distal, consider symptomatic therapy with compresses, NSAID’s and continued observation If proximal (above knee), consider LMWH with or without transition to Warfarin (INR 2–3) particularly with clots within 2cm of deep venous system Duration of therapy 1–3 months
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| Calf vein thrombosis |
Initial therapy with UFH, LMWH, or Fondaparinux with transition over 5–7 days to Warfarin (INR 2–3) or LMWH for acute and chronic therapy Duration of therapy 3 months If anticoagulation contraindicated, consider serial duplex surveillance If calf vein DVT progresses to involve proximal deep veins and anticoagulation is contraindicated, consider retrievable vs. permanent vena cava filter
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| Recurrent VTE |
If currently on Warfarin switch to LMWH or treat for 5–7 days with UFH, LMWH, or Fondaparinux in transition to therapeutic INR (if INR sub therapeutic at time of event) If on LMWH- check dose, consider LMWH level vs. empiric dose increase, switch to Fondaparinux If recent initiation of UFH or LMWH, consider HIT Look for anatomic reason for recurrence Consider vena cava filter
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| Vena Cava filter |
If a retrievable filter is placed, follow the patient closely and retrieve the filter when anticoagulation is no longer contraindicated If a permanent filter is placed and anticoagulation is no longer contraindicated, consider indefinite anticoagulation
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