TREATMENT PLAN, PROGNOSIS, TRAVEL ADVICE

TREATMENT PLAN 

First-line:

• Apixaban: 10mg BD for 7 days then 5mg OD with food
• Rivaroxaban: 15mg BD for 21 days then 20mg OD

Second-line:

• LMWH (dalteparin/enoxaparin/tinzaparin/fondaparinux) for 5 days then:
• Dabigatran: 150mg BD (110mg BD if >80yrs)
• Edoxaban: 60mg OD (30mg OD if <61kg)

Warfarin:

• Should be started within 24 hours, usually with a LMWH/Fondaparinux until the INR >2 – Initial dose 10mg for 2 days
• Continue 3-9mg based on INR
• Target INR 2-3/2.5

General Treatment Duration:

• Distal DVT: 6 weeks
• Proximal DVT with risk factors: 3 months (PROVOKED)
• Proximal DVT without risk factors: 6 months (UNPROVOKED)
• Recurrent DVT/PE: long-term

Special considerations:

• Pregnancy/immediate postpartum: same-day assessment
• Investigate unprovoked DVT for underlying causes (?cancer/?thrombophilia testing)

PROGNOSIS 

Complications:

• Pulmonary embolism
• Post-thrombotic syndrome (chronic venous HTN) within 2 years: pain, swelling, hyperpigmentation, dermatitis, ulcers, Venous gangrene, Lipodermatosclerosis – Heparininduced thrombocytopenia (rare with LMWH): five days post-exposure

TRAVEL ADVICE 

• No flying for 2 weeks post-DVT
• Cast: 24hr restriction for flights <2hrs, 48hr restriction for >2hrs
• Flights >4hrs: consider prophylaxis in high-risk patients
• Pregnancy & >4hrs flight: seek specialist advice if additional risk factors (<4 hour flights are ok)

General travel advice:

• Regular movement
• Exercises
• Adequate hydration
• Consider compression stockings (after ABPI assessment) – Consider LMWH 2 – 4 hours pre-flight in high-risk cases.

DVT Reference