Deep vein thrombosis and its treatment in questions and answers.

Authors: M. Berková;  Z. Berka;  E. Topinková
Published in: Geriatrie a Gerontologie 2016, 5, č. 1: 19-27
Category: Review Article


Deep vein thrombosis (DVT) affects 1–2 people out of 1000 per year. It is 10x more common among elderly people than among people under the age of 30. Deep vein thrombosis most commonly affects distal parts of the deep vein system (calves and under the knee). The diagnostic method of choice is ultrasound examination. Pharmacological therapy of DVT is based on anticoagulation therapy: heparin, low molecular weight heparin, pentasaccharides (currently unavailable in the Czech Republic), for long term therapy, warfarin is available, along with new peroral anticoagulants. Hirudin-based drugs and argatroban remain reserved for certain specific conditions – for example for heparin-induced type II thrombocytopenia. In indicated cases of DVT, intervention treatment is used (local thrombolysis, endovascular procedures with special catheters for fragmentation and aspiration of thrombi or stent implantations). When treating DVT, non-pharmacological measures are essential – in haemodynamically stable patients, an early mobilisation is possible, as soon as pain passes, using bandages, compression garments or in bed-ridden patients, plantar flexion. For patients treated with warfarin, we do not recommend the “warfarin diet”, but a diet with a constant supply of nutrients. The length of pharmacotherapy depends on the aetiology of the disease – secondary DVT is treated for a minimum of 3 months, idiopathic for at least 6 months and patients with persisting pro-thrombotic condition and repeated DVTs are treated perpetually. Even in spite of efficient anticoagulation therapy, chronic post-thrombotic syndrome develops in up to 50 % of patients, especially in cases of proximal DVT. HIT II represents a specific issues, caused by antibodies against heparin with platelet factor 4, which form roughly since the 4th day of heparin therapy and lead to serious intravascular thromboses. It occurs in 1–3 % patients treated with non-fractioned heparin and in less than 0.1% people treated with low molecular weight heparin. A 30 % or higher decrease of thrombocytes is typical for this condition. This is why examinations of the level of thrombocytes are necessary while patients are on heparin, every other day, between the 4th and 14th day of the treatment. Idiopathic phlebothrombosis can be a symptom of a hidden malignancy in almost 10 % of elderly patients. When looking for a malignancy in cases of seemingly idiopathic DVT, we focus on diligently examining the patient’s medical history, physical examinations, basic haematological and biological examinations and x-rays of the chest. Further examinations of the urogenital system and colonoscopies are recommended in patients over a certain age, in case the patient has not undergone these examinations as a part of routine preventive examination or if a malignancy is suspected based on the basis of the prior examinations. The most common malignancies discovered this way include leukaemia, urogenital and gastrointestinal tumours.

deep vein thrombosis – diagnostics – treatment – advanced age


1. Skalická L. Hluboká žilní trombóza – klinická manifestace a diagnostika. Postgrad Med 2006; 8(4): 415–421.

2. Silverstein MD, Heit JA, Mohr DN, et al. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med 1998; 23(6): 585–593.

3. Tagalakis V, Patenaude V, Kahn SR, Suissa S. Incidence and mortality from venous thromboembolism in a real-world population: the Q–VTE Study Cohort. Am J Med 2013; 126(9): 832: 13–21.

4. Ouriel K, Green RM, Greenberg RK, Clair DG. The anatomy of deep venous thrombosis of the lower extremity. J Vasc Surg 2000; 31: 895-900.

5. Hirmerová J, Karetová D, Malý R a kol. Akutní žilní trombóza 2014: současný stav prevence, diagnostiky a léčby. Doporučený postup České angiologické společnosti ČLS JEP. Dostupné z:

6. Joffe HV, Goldhaber SZ. Upper extremity vein thrombosis. Circulation 2002; 106: 1874–1880.

7. Musil D. Diagnostika a léčba tromboembolické nemoci v ambulanci praktického lékaře. Med praxi 2011; 8(5): 238–241.

8. Herman Jiří, Musil D. Žilní onemocnění v klinické praxi. Praha: Grada Publishing 2011: 113–137

9. Štverák P, Matoška P, Stolařová I a kol. Naše zkušenosti s implantací kaválního filtru Trapease. Interv Akut Kardiol 2004; 3: 177–180.

10. Čížek V, Kučera D, Válka M, a kol. Kavální filtry. Postgrad med 2010; 10(1): 83–91.

11. Riegerová B, Malý R, Lojík M, a kol. Heparinem indukovaná trombocytopenie II. typu u komplikované ileofemorální flembotrombózy léčené katétrem řízenou trombolýzou. Interní Med 2008; 10 (7 a 8): 358–360.

12. Holotňáková I, Branny P, Nevřalová R, a kol. Masivní intrakardiální trombóza jako projev heparinem indukované trombocytopenie II. typu po léčbě nadroparinem po kardiochirurgické operaci. XX. výroční sjezd ČKS, 13.–16. 5. 2012, Brno.

13. Jun M, James MT Manns BJ, et al. The association between kidney function and major bleeding in older adults with atrial fibrillation starting warfarin treatment: population based observational study. BMJ 2015; 350: 246.

14. Schulman S; RE-MEDY; RE-SONATE trial Iivestigators. Extended use of dabigatran, warfarin, or placebo in venous thromboembolism. N Engl J Med 2013; 368: 709–718.

15. Buller HR, Prins MH, et al. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med 2012; 366: 1287–1297.

16. Eriksson BI, Borris LC, Friedman RJ, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after hip arthroplasty. N Engl J Med 2008; 358: 2765–2775, 2776–8276.

17. Bauersachs R, Berkowitz SD, Brenner B, et al. Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med 2010; 363(26): 2499–2510.

18. Kvasnička T. Nová perorální antikoagulancia – vliv na koagulační testy. Medicína po promoci 2014; 4: 16.

19. Roumen-Klappe EM, Heijer M, Janssen MC, et al. The post-thrombotic syndrome: incidence and prognostic value of non-invasive venous examinations in a six-year follow-up study. Thromb Haemost 2005; 94(4): 825–830.

20. Baldwin MJ, Moore HM, Rudarakanchana N. Post-thrombotic syndrome: a clinical review. J Thromb Haemost 2013; 11(5): 795–805.

21. Kahn SR. The post-thrombotic syndrome: progress and pitfalls. Br J Haematol 2006; 134(4): 357.

22. Hettiarachchi RJ, Lok J, Prins MH, et al. Undiagnosed malignancy in patiens with deep venous thrombosis. Cancer 1998; 83: 180–185.

23. Carrier M, Lazo-Langner A, Shivakumar S, et al. Screening for Occult Cancer in Unprovoked Venous Thromboembolism. N Engl J Med 2015; 373: 697–704.

24. Kelly J, Rudd T, Lewis R,et al. Occult cancer in older patiens presenting with venous thromboembolism. Age and Ageing 2002; 31: 101–104.

25. Prandoni P, Picciolo A, Girolami A. Cancer and venous thromboembolism: an overview. Haematologica 1999; 84: 437–445.

26. NICE guidelines 2012 [CG144]. Venous thromboembolic diseases: diagnosis, management and thrombophilia testing. Dostupné z:

27. Piccioli A, Bernardi E, Dalla Valle F, et al. The value of CT-scanning for detection of occult cancer in patients with unprovoked venous thromboembolism. J Thromb Haemost 2013; 11: Suppl 2: AS 34.1–AS 34.1

28. Piccioli A, Bernardi E, Prandoni P. Cancer Screening in Unprovoked Venous Thromboembolism. N Engl J Med 2015; 373: 2473–2475.

Geriatrics General practitioner for adults Orthopaedic prosthetics
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