What are the signs and treatment of Deep Vein Thrombosis (DVT)?

From the Guidelines

Deep Vein Thrombosis (DVT) typically presents with signs such as swelling in the affected limb, pain that often starts in the calf, red or discolored skin, and warmth in the affected area, and treatment should begin promptly with anticoagulant medications to prevent complications like pulmonary embolism. The signs of DVT can be subtle, and some patients may experience only mild symptoms or none at all, making diagnosis challenging.

• Common signs and symptoms include:
  • Swelling in the affected limb (usually one leg)
  • Pain that often starts in the calf
  • Red or discolored skin
  • Warmth in the affected area
• Treatment typically begins with anticoagulant medications such as low molecular weight heparin (enoxaparin 1mg/kg twice daily), unfractionated heparin, or direct oral anticoagulants like rivaroxaban (15mg twice daily for 21 days, then 20mg once daily) or apixaban (10mg twice daily for 7 days, then 5mg twice daily) 1.
• Treatment duration ranges from 3-6 months for provoked DVT and may be longer or indefinite for unprovoked cases, as recommended by the most recent guidelines 1.
• Compression stockings help reduce swelling and prevent post-thrombotic syndrome.
• During treatment, patients should stay active as tolerated rather than remaining immobile, elevate the affected limb when resting, and monitor for signs of bleeding (a medication side effect) or pulmonary embolism (shortness of breath, chest pain, rapid heartbeat).
• DVT occurs when blood clots form in deep veins, usually due to immobility, surgery, pregnancy, cancer, or genetic clotting disorders, and prompt treatment is essential to prevent complications like pulmonary embolism, as highlighted in recent studies 1.

From the FDA Drug Label

In the EINSTEIN DVT and EINSTEIN PE studies, XARELTO was demonstrated to be non-inferior to enoxaparin/VKA for the primary composite endpoint of time to first occurrence of recurrent DVT or non-fatal or fatal PE

• The signs of a DVT to educate a patient about include:
  • Swelling of the leg or arm
  • Pain or tenderness in the leg or arm
  • Warmth or redness of the skin on the affected leg or arm
  • Weakness or fatigue
• The treatment of DVT includes anticoagulation therapy, such as XARELTO, to prevent the formation of new blood clots and to reduce the risk of recurrent DVT or PE 2
• It is essential to note that the provided drug label does not explicitly list all the signs of DVT, and the above list is not exhaustive.
• Patients should be instructed to seek medical attention immediately if they experience any signs or symptoms of DVT or PE, such as sudden onset of shortness of breath, chest pain, or severe leg pain 2

From the Research

Signs of Deep Vein Thrombosis (DVT)

• Pain in the affected limb 3
• Swelling in the affected limb 3
• Erythema (redness) in the affected limb 3
• Dilated veins in the affected limb 3

Diagnosis of DVT

• Clinical assessment 3, 4
• Evaluation of pre-test probability 3
• Objective diagnostic testing, such as D-dimer test and compression ultrasound 3, 4
• Clinical decision rule to stratify DVT into "unlikely" or "likely" 3

Treatment of DVT

• Anticoagulation therapy to control symptoms, prevent progression, and reduce the risk of post-thrombotic syndrome and pulmonary embolism 3, 5
• Direct oral anticoagulants (DOACs) as the preferred treatment for DVT, which are at least as effective, safer, and more convenient than warfarin 3, 5
• DOACs, such as apixaban or rivaroxaban, may be used without initial parenteral therapy 3
• Anticoagulation therapy should be stopped in patients with provoked VTE and in those with unprovoked VTE and a high bleeding risk after an initial period of 3-6 months 6

Special Considerations

• DVT in patients with cancer may be treated with edoxaban or rivaroxaban, but the risk of gastrointestinal bleeding is higher with DOACs than with low molecular weight heparin (LMWH) in patients with gastrointestinal cancer 3
• DVT during pregnancy requires special consideration, and the diagnosis and treatment may be more problematic 4
• The diagnosis of ipsilateral recurrent DVT poses a particular challenge and requires a separate algorithm 7