thrombophilia blood testing should NOT be done until at least 2 weeks after ceasing anticoagulation Rx, if at all - there is no need to routinely perform it, and it should not be done during an acute DVT event
basic screening should be done for occult malignancy - see thrombophilia
consider admission under general medicine unit if high risk, otherwise admit to HITH
if involving iliac vessels then vascular consult to consider need for IVC filter or thrombolysis if massive thrombosis.
if below knee DVT and not pregnant:
if minor below knee thrombosis and relative C/I to warfarin then:
consider aspirin (acetylsalicylic acid) only (1x 300mg tablet per day) with rpt US in 7 days and at 14 days and if becomes above knee then re-consider risk/benefit of warfarin Rx.
if below knee DVT and no other C/I to outpatient care, then commence anticoagulation either via:
hospital in the home:
consider admission to short stay observation unit (SSU) if delays in obtaining home nursing Mx.
if minor DVT, then consider just a stat dose enoxaparin 1mg/kg s/c and start warfarin
if more significant DVT, then consider enoxaparin 1mg/kg bd s/c until INR therapeutic following starting warfarin Rx.
enoxaparin 1.5mg/kg once daily sc may be used if not high risk such as iliac vein thrombosis, obese or has cancer.
patient may be suitable for self-injecting enoxaparin with education, otherwise via LMO or worse case, return to ED.
consider option of 1 week Rx with enoxaparin without warfarin, then rpt USS at 1 week, if no propagation, with-hold warfarin Rx, and repeat USS in another week (ie. day 14), if still no propagation then just Mx with support stockings.