Outpatient treatment of proximal deep vein thrombosis.

The treatment of deep vein thrombosis (DVT) is based on anticoagulation with heparin, warfarin and direct oral anti-coagulants. According to the 9th ACCP Recommendation, for patients with DVT of the lower limbs, where the clinical state and home conditions permit, preference is given to home treatment over hospitalization. Despite that, the majority of patients with acute DVT still tend to be hospitalized, in particular when proximal thrombosis from the popliteal vein upward is involved. Furthermore, the recommendations do not describe proximal (iliofemoral) DVT as exceptional and more serious. Randomized and observation studies have shown faster relief from pain and swelling in patients keeping to the regimen of early mobilization wearing compression means, compared to patients keeping bed rest, while the incidence of new cases of PE was the same for both groups. In the acute phase of the disease compression and walking exercise is essential which, along with internal thrombolytic mechanisms of the body, accelerates recanalization and development of the collateral blood vessels in the deep muscular compartment of the lower limb. Two case studies demonstrate an outpatient approach to the therapy of proximal DVT. Key words: compression treatment - direct oral anticoagulants - low molecular weight heparin - venous thromboembolism.