Initial Anticoagulant Management of Deep Vein Thrombosis/Venous Thromboembolism in Primary Care: Review of Current Approaches

Background and Aims: The initial management of deep vein thrombosis is starting to happen in general practice. New treatments are available to allow this shift, but guidance is variable. The aim of this study was to understand current choices used in general practice in the UK and to determine if there is a more efficient treatment, considering variability observed locally. Methods: A systematic literature review and freedom of information requests to England’s 198 clinical commissioning groups (CCG) were used to gather information on treatment options and current uses, respectively. Over 100 papers were assessed, and information from 177 CCG was obtained. Results: There is noninferiority between injectable low-molecular-weight heparin and novel oral anticoagulant treatments. Fifteen CCG offered variable, but also limited, options of treatment. Patient choice was not necessarily considered. Conclusion: There is variability in England on availability and choice of therapy for the initial management of deep vein thrombosis at present, which may also be the case elsewhere. The implementation of evidence-based guidelines should be carefully considered in all settings and countries.