Acute deep vein thrombosis: who still needs hospital admission?

Hospital admission for acute deep vein thrombosis (DVT) was historically considered mandatory, reflecting the therapeutic limitations and safety concerns of previous decades. Over time, advances in anticoagulant therapy, diagnostic strategies, and healthcare organization have profoundly changed this paradigm. Low-molecular-weight heparins and, more recently, direct oral anticoagulants (DOACs) have enabled effective and safe outpatient treatment for a large proportion of patients. Nonetheless, hospitalization remains common in clinical practice, often driven by habit, uncertainty, or organizational barriers rather than clear evidence-based indications. This Perspective summarizes the evolution of DVT management, integrates contemporary evidence and guidance, and proposes a pragmatic framework to identify patients who still benefit from hospitalization. The emphasis is on physician-led decision-making that integrates thrombotic and bleeding risk, comorbidities, the extent of thrombosis, and social and system-level factors. Rather than considering hospitalization as the default treatment, we advocate a deliberate, personalized triage approach aligned with contemporary internal medicine practice.