Deep vein thrombosis


Provoked (surgery, trauma, immobilization, travel, or estrogen exposure, Persistent like cancer) vs unprovoked (No identifiable trigger)

[Age]-yo [M/F] with PMH of..., presenting with
*** days
constant/intermitent
progressively worsening/improving
CC: leg swelling and pain
PP: unilateral calf swelling, pain, warmth, mild erythema
PN: denies chest pain, dyspnea, fever, NO surgery, trauma, immobilization, travel, or estrogen exposure, Persistent like cance
pertinent SHx: tobacco, EtOH, drug use
initial DATA: CBC/CMP, Duplex ultrasound
pending DATA:
MEDS:
COURSE:

Plan

  • start heparin drip → transition to DOAC

    • Eliquis 10 mg BID × 7 days -> 5 mg BID

    • Rivaroxaban (Xarelto) 15 mg BID × 21 days -> 20 mg daily (with food)

    • UFH bridge to Warfarin in CrCl <15, Mechanical heart valves, Antiphospholipid syndrome,

  • Provoked DVT: 3 months, Unprovoked: ≥3 months-lifelong (recurrent DVT, proximal clot and and low bleeding risk)

  • trend CBC (Hgb/platelets), RFP,

  • monitor for signs of bleeding

  • monitor for PE symptoms, chest pain, dyspnea, hypoxia, tachy

  • PT/OT for eval

  • follow up with PCP to reassess recurrence risk vs bleeding risk) and determine duration of therapy.