All::Haematology::Diseases::Deep vein thrombosis
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What is a DVT?
A thrombus in the deep veins of the body usually the legs
Deep vein thrombosisWhat Wells score would a DVT be considered likely?
2 points or more likely
Deep vein thrombosisWhat Wells score would a DVT be considered unlikely?
1 point or less unlikely
Deep vein thrombosisWhen should age adjusted d-dimer cutoff be used?
In patients over 50
Deep vein thrombosisWhat is recommended if a DVT is 'likely'?
Proximal leg vein ultrasound within 4 hours, start anticoagulant if positive, consider alternative diagnoses if negative
Deep vein thrombosisWhat do you for a suspected DVT if d-dimer is positive but doppler is negative?
stop interim therapeutic anticoagulation , offer a repeat proximal leg vein ultrasound scan 6 to 8 days later
Deep vein thrombosisWhat if a proximal leg vein ultrasound can't be done within 4 hours in a likely DVT?
administer interim therapeutic anticoagulation
Deep vein thrombosisWhat is recommended if DVT is 'unlikely'?
Perform D-dimer within 4 hours, if negative consider alternative diagnosis, if positive do USS doppler
Deep vein thrombosisWhat is the cornerstone of VTE management?
Anticoagulant therapy
Deep vein thrombosisWhat changed in the choice of anticoagulant in the 2020 guidelines?
Increased use of DOACs
Deep vein thrombosisWhat DOACs are recommended first-line for DVT?
Apixaban or rivaroxaban
Deep vein thrombosisWhat should be offered if apixaban or rivaroxaban are not suitable for DVT?
LMWH followed by dabigatran or edoxaban OR LMWH followed by a vitamin K antagonist (warfarin)
Deep vein thrombosisWhat is recommended for DVT in patients with active cancer?
DOAC, unless contraindicated
Deep vein thrombosisWhat is recommended for severe renal impairment in anticoagulation?
LMWH, unfractionated heparin, or LMWH followed by warfarin
Deep vein thrombosisWhat is recommended for antiphospholipid syndrome in anticoagulation?
LMWH followed by a warfarin
Deep vein thrombosisHow long should all patients have anticoagulation?
At least 3 months
Deep vein thrombosisWhen is anticoagulation typically stopped for provoked VTE?
After the initial 3 months (3 to 6 months for people with active cancer)
Deep vein thrombosisHow long is treatment continued for unprovoked VTE?
Up to 3 further months (total 6 months)
Deep vein thrombosisWhat can be used to assess the risk of bleeding on anticoagulation?
ORBIT score
Deep vein thrombosisWhat do NICE recommend regarding continuing anticoagulation for unprovoked DVT or PE with low bleeding risk?
Likely to outweigh the risks, recommend continuing for a total of 6 months
Deep vein thrombosis