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Mx of lower limb DVT

see also:

  • for unprovoked DVT:
    • 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

Mx of confirmed DVT in ED:

if pregnant:

  • discuss with O&G reg., remember warfarin C/I in pregnancy due to teratogenic effects.

if above knee DVT and not pregnant:

  • then enoxaparin and warfarin Rx
    • 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:
      • 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.
    • 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

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