Most cases of Deep Venous Thrombosis require anticoagulation.
The newer agents – rivaroxaban and apixaban have made it much easier for GPs to manage DVT in the community. Most patients can be started on initial monotherapy with either medication without the use of heparin, as long as they can access the medication promptly.
Patients will need an initial more intense phase of anticoagulation followed by maintenance dosing.
- Rivaroxaban – 15mg BD for 21 days followed by 20mg once daily.
- Apixaban – 10mg twice daily for 7 days followed by 5mg twice daily.
Please make sure patients have a creatinine clearance >30mls/min before using the above regimens as dose adjustments will be necessary.
Just as important as the anticoagulation (especially in preventing post thrombotic syndrome of the leg) is making sure the patient has a properly fitted Level 2 compression stocking. If a patient has previously been treated at Vein Care SA they will already have a compression stocking(s). Please refer the patient to Vein Care SA if a compression stocking is required.
The rate of DVT following Ultrasound-Guided Sclerotherapy treatment is approximately 1% in our patient population.
Duration of treatment:
The duration of treatment depends on the location of the DVT, whether it is the first presentation and whether it was provoked or unprovoked.
Below knee DVT – continue anticoagulation for 6 weeks to 3 months, as guided by surveillance ultrasound.
Above knee DVT – Continue anticoagulation for at least 3 months if provoked and 6 months if unprovoked. Use surveillance ultrasound to guide treatment.
Factors that would indicate consideration of ongoing long-term anticoagulation:
- first episode in a patient with cancer
- recurrent idiopathic DVT
- recurrent DVT with associated thrombophilia
- prolonged immobility with previous DVT