What should a patient do when diagnosed with a Deep Vein Thrombosis (DVT)?

Management of Deep Vein Thrombosis (DVT)

Patients diagnosed with deep vein thrombosis should immediately start anticoagulation therapy for at least 3 months, with direct oral anticoagulants (DOACs) as first-line treatment for most patients. 1

Immediate Actions After DVT Diagnosis

Anticoagulation Therapy

• Begin anticoagulation therapy immediately upon diagnosis
• First-line options (in order of preference):
  • DOACs: Apixaban (10mg twice daily for 7 days, then 5mg twice daily) or Rivaroxaban (15mg twice daily for 21 days, then 20mg once daily) 2
  • Low molecular weight heparin (LMWH) if DOACs contraindicated
  • Warfarin (with initial LMWH overlap until INR 2.0-3.0) if other options unavailable 3

Activity and Positioning

• Do not maintain strict bed rest - early mobilization is recommended
• Elevate the affected limb when sitting or lying down
• Avoid prolonged standing or sitting in one position
• Resume normal activities gradually as symptoms improve

Compression Therapy

• Apply graduated compression stockings (30-40 mmHg at ankle) for symptomatic relief 2
• Wear compression stockings during the day for at least 2 years to reduce risk of post-thrombotic syndrome

Duration of Anticoagulation

The duration of anticoagulation depends on the circumstances of the DVT:

1. Provoked by major transient risk factor (surgery, trauma):

   • 3 months of anticoagulation, then stop 1

2. Provoked by minor transient risk factor:

   • 3 months of anticoagulation, then stop 1

3. Unprovoked DVT or persistent risk factors:

   • Consider extended anticoagulation (no scheduled stop date) 1
   • For first unprovoked DVT with low/moderate bleeding risk: extended therapy recommended
   • For first unprovoked DVT with high bleeding risk: 3 months only

4. Cancer-associated DVT:

   • Extended anticoagulation (no scheduled stop date) 1
   • Reassess annually and at times of significant health changes

What to Avoid

• Do not massage the affected leg
• Do not apply direct heat to the affected area
• Do not wear restrictive clothing that could impair circulation
• Do not take long flights or car trips without frequent movement and hydration
• Do not stop anticoagulation without consulting healthcare provider
• Do not take NSAIDs or aspirin without medical approval (increased bleeding risk)

Monitoring and Follow-up

• Return for follow-up assessment at 3 months to determine if extended therapy is needed 1
• Monitor for signs of bleeding complications (unusual bruising, blood in urine/stool)
• Watch for symptoms of pulmonary embolism (sudden shortness of breath, chest pain)
• Monitor for extension of DVT (increased pain, swelling, or warmth)
• If on warfarin, maintain regular INR monitoring (target 2.0-3.0) 3

Special Considerations

High Bleeding Risk Patients

• Consider shorter duration of therapy (3 months) 1
• More frequent monitoring for bleeding complications

Cancer Patients

• Oral factor Xa inhibitors (apixaban, edoxaban, rivaroxaban) preferred 1, 2
• Use caution with edoxaban or rivaroxaban in GI malignancies (higher bleeding risk) 1

Pregnancy

• DOACs and warfarin are contraindicated
• LMWH is the treatment of choice 2

Warning Signs to Seek Immediate Medical Attention

• Sudden shortness of breath or chest pain (possible pulmonary embolism)
• Significant increase in leg pain, swelling, or warmth (possible extension)
• Signs of bleeding: blood in urine/stool, severe headache, unusual bruising
• Severe leg pain with bluish discoloration (possible phlegmasia cerulea dolens)

By following these guidelines, patients can effectively manage DVT, reduce the risk of complications such as pulmonary embolism and post-thrombotic syndrome, and improve their quality of life during recovery.