Embolic Disorders

DVT and PE

What is the appropriate duration of treatment for a patient with proximal unprovoked DVT or PE?

3-6 months, and also consider extended therapy with either:

• Apixaban 2.5mg twice daily

• Rivaroxaban 10mg once daily

What is the appropriate duration of treatment for a patient with proximal provoked DVT or PE?

3 months

What is the appropriate duration of treatment for a patient with distal unprovoked DVT?

3 months

What is the appropriate duration of treatment for a patient with distal provoked DVT?

6 weeks

What is the order of preference for treatment of acute DVT or PE?

1. Apixaban or rivaroxaban

2. Treat with heparin or LMWH for 5 days, then stop and switch to dabigatran

3. Warfarin, and also treat concurrently with heparin or LMWH for 5 days or until INR > 2

4. LMWH or heparin, which are preferred agents in pregnant patients or patients with cancer-associated VTE

What is the preferred agent for DVT prophylaxis for most patients?

Enoxaparin

When is it appropriate to use DOACs for DVT prophylaxis?

Apixaban, rivaroxaban or dabigatran can be used for patients following hip or knee replacement surgery.

When is it most appropriate to use unfractionated heparin for DVT prophylaxis?

For patients with severe renal impairment, or when rapid reversal of anticoagulation may be necessary.

When is thrombolysis indicated for DVT or PE?

• Haemodynamically unstable PE

• Proximal, especially ileofemoral, DVT

What agents may be used for thrombolysis of DVT or PE?

Alteplase or tenecteplase.