Duration of treatment of deep vein thrombosis: time for a new approach?

The American College of Chest Physicians Consensus Conference on Antithrombotic Therapy recommends that patients with initial idiopathic deep vein thrombosis (DVT) receive treatment for at least 6-12 months. However, controversy exists as to what treatment duration and intensity are optimal. Some investigators have suggested that it may be feasible to identify patients who are at low risk and those who are at high risk of recurrent venous thromboembolism. If patients can be stratified according to risk, then it might be safe and effective to withdraw oral anticoagulation therapy in those at low risk of recurrence and continue the therapy in those at high risk. Parameters that have been used to attempt to stratify patients with idiopathic DVT according to risk are D-dimer levels, resolution of thrombosis on ultrasound, and sex.