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● DVT and pulmonary embolism (PE) are the two forms of venous thromboembolism (VTE). Treatment is commenced with a low molecular weight heparin s.c. at a weight- and kidney function-adjusted dosage. The alternative fondaparinux induces no type II heparin-induced thrombocytopenia (HIT II) but it cannot be antagonized in case of bleeding.
● Heparin or fondaparinux treatment is commenced in most patients together with warfarin/phenprocoumon and discontinued once a stable INR of >2.0 has been reached. In early post-surgery patients the warfarin/phenprocoumon treatment is delayed until the bleeding risk has normalized.
● The acute treatment of at least 5 days is followed by a secondary DVT thromboprophylaxis of variable length with warfarin/phenprocoumon. Three months suffice after a first thrombosis with a known provoking factor (e.g. trauma or post-surgery). Recurrent idiopathic DVT requires life-long anticoagulation.
● Both treatment and the secondary prophylaxis can be alternatively conducted with new oral anticoagulants such as rivaroxaban. This eliminates the need for thrombocyte and (in some patients) factor Xa activity monitoring during heparin treatments as well as the laborious warfarin/phenprocoumon dosage finding and follow-up INR measurements.