Clinical practice guidelines by the American College of Chest Physicians guide management.
Anticoagulation therapy is the mainstay of the treatment of deep vein thrombosis (DVT). The<unk>  treatment of DVT consists of an initial parenteral anticoagulation therapy and a long term anticoagulation therapy. The primary purpose of treatment is to prevent further clot extension, acute pulmonary embolism, recurrence of thrombosis, and late complications such as post-thrombotic syndrome and chronic thromboembolic pulmonary hypertension.  The treatment of DVT with parental anticoagulation should be initiated in case of intermediate or high suspicion of suspected DVT even before the diagnostic confirmatory tests are complete.  The choice of parental anticoagulation include: low molecular weight heparin (LMWH), fondaparinux, IV unfractionated heparin (UFH) and SC-UFH; however, the administration of LMWH (once daily rather than twice daily) and fondaparinux is recommended over IV-UFH and SCUFH.  Parental anticoagulation therapy should be administered for at least 5 days and until the INR is equal or more than 2 for more than 24 hours.  Patients who receive long term therapy with anticoagulation should be assessed regularly for the risks vs benefits of anticoagulation therapy.  An abnormal D-dimer level at the end of treatment may signal the need for continued treatment in patients with their first unprovoked proximal DVT.
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