Table of Contents
Mx of lower limb DVT
- for unprovoked DVT:
Mx of confirmed DVT in ED:
- support stockings (eg. TED stockings)
- discuss with O&G reg., remember warfarin C/I in pregnancy due to teratogenic effects.
if above knee DVT and not pregnant:
- 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:
- 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.
- LMO only Rx with warfarin:
- guidelines on starting anticoagulation and warfarin Rx - good to print out for GPs
- 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.
- LMO Rx with rivaroxaban:
- PBS authority script for proven DVT
- 1st 3wks initial Rx 15mg bd o rivaroxaban
- if minor below knee DVT, consider repeat US in 1-2wks and if no propagation, can cease Rx
dvt_mx.txt · Last modified: 2020/04/18 01:45 by gary1