MANAGEMENT OF DEEP VEIN THROMBOSIS MOHW AUGUST 2020

Reference: Venous thromboembolic diseases: diagnosis, management and thrombophilia testing. NICE guideline Published: 26 March 2020
www.nice.org.uk/guidance/ng158
 *Two level DVT Wells score:
 Active cancer (treatment
Signs and symptoms of DVT: ongoing, within 6 months, or
Unilateral painful lower limb swelling with palliative) = 1
calf tenderness  Paralysis, paresis or recent
plaster immobilisation of the
lower extremities = 1
Assessement with 2 level Wells
 Recently bedridden for 3
score* days or more, or major
surgery within 12 weeks
requiring general or regional
anaesthesia = 1
 Localised tenderness along
the distribution of the deep
Score <2 Score 2 or venous system = 1
more  Entire leg swollen = 1
 Calf swelling at least 3 cm
Send D Dimer** larger than asymptomatic
Start anticoagulation side = 1
with LMWH or UFH  Pitting oedema confined to
D Dimer D Dimer the symptomatic leg = 1
raised normal  Collateral superficial veins
Request echo doppler of (non-varicose) = 1
lower leg veing as soon as  Previously documented DVT
possible(within 24hrs) =1
Request Echo doppler
 An alternative diagnosis is at
of lower leg veins
least as likely as DVT = -2

Negative Positive
Positive Negative

DVT excluded :
DVT confirmed :
Stop anticoagulation
Start anticoagulation
DVT Confirmed Look for another cause with warfarin
Duration ofanticoagulation:
Start anticoagulation of limb swelling  Provoked DVT : 3months
with LMWH or UFH Adjust warfarin dose
and warfarin until INR is 2-3 on 2
consecutive days and  Unprovoked DVT: >3months
stop LMWH/UFH (case by case)

Low molecular weight Unfractionated Heparin

**D Dimer is used to rule out
heparin (LMWH) – (UFH) – Heaprine Na
 Used in case eGFR<15ml/min
DVT/PE in case of low suspicion. It
Enoxaparin
 Dose 50IU/kg BW bolus does not confirm DVT/PE. High D
 Dose 0.01ml/kg BW BD
 Dose reduced if eGFR15- followed by 20IU/kg BW/hr Dimers can be seen in pregnancy,
30ml/min  Adjust according to PTTk postoperatively, infection, trauma,
malignancy, DIC, liver disease and
other hypercoagulable states.

Reference: Venous thromboembolic diseases: diagnosis, management and thrombophilia testing. NICE guideline Published: 26 March 2020
www.nice.org.uk/guidance/ng158