Introduction

Venous thromboembolism (VTE), encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common disorder affecting approximately 900,000 patients annually in the United States. DVT occurs when a blood clot forms in a deep vein, usually in the legs. This can lead to serious complications such as PE, which occurs when the clot breaks off and travels to the lungs. As many as one-third of DVT cases are complicated by PE, which can be fatal in up to 25% of cases.

Pharmacists play a critical role in the acute management of DVT by selecting appropriate anticoagulant therapy, monitoring efficacy and safety, providing patient education, and preventing recurrence. Key aspects of DVT management include prompt initiation of anticoagulation, patient risk stratification, optimal drug selection and dosing, transition of care from inpatient to outpatient, duration of therapy, and monitoring for adverse effects like bleeding. Recent advancements include the development of direct oral anticoagulants (DOACs) like apixaban and rivaroxaban, which provide effective anticoagulation without routine monitoring. However, debate continues around optimal duration of therapy and which patients are candidates for extended anticoagulation.

This section will cover pharmacologic options for acute DVT treatment including heparin, low molecular weight heparins, warfarin, and DOACs. Key considerations for drug selection, dosing, transition of care, duration of therapy, monitoring, and adverse effect management will also be discussed.