International Clinical Practice Guidelines for Acute Deep Vein Thrombosis: A Comparative Review of Recommendations, Evidence Gaps, and Emerging Trends

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Background: Acute deep vein thrombosis (DVT) remains a major cause of morbidity and mortality worldwide. Although several international societies have published evidence-based clinical practice guidelines, several important differences persist. This review compares contemporary international guidelines to identify areas of consensus, controversy, and future research priorities. Methods: A narrative comparative review was conducted using the most recent evidence-based international guidelines. Recommendations were compared across diagnostic evaluation, anticoagulant selection, treatment duration, outpatient management, catheter-directed interventions, compression therapy, special populations, and pediatric venous thromboembolism. Results: All guidelines recommend structured diagnostic algorithms integrating clinical pretest probability, D-dimer testing, and compression ultrasonography, while favoring direct oral anticoagulants as first-line therapy for most patients. Major differences remain regarding the management of isolated distal DVT, optimal duration of anticoagulation, indications for catheter-directed thrombolysis, use of compression therapy, and treatment of special populations, including patients with cancer, antiphospholipid syndrome, obesity, pregnancy, and pediatric DVT. These variations largely reflect differences in evidence interpretation, healthcare resources, regional epidemiology, and implementation strategies rather than fundamental disagreement. Persistent evidence gaps include pediatric DVT, isolated distal DVT, optimal duration of secondary prevention, and patient selection for endovascular therapies. Conclusions: Contemporary international DVT guidelines demonstrate substantial agreement regarding core management principles but differ in several clinically important areas where evidence remains limited. Future harmonization will require high-quality randomized studies, broader international collaboration, and integration of emerging precision medicine approaches, including artificial intelligence, and novel anticoagulant therapies, to support globally applicable, evidence-based DVT management.

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