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