By vgreene, 12 March, 2021 If pt on extended VKA use INR 2 0 3 0 if on DOAC consider continued standard dosing over lower dosing per ASH 6 but ACCP suggests reduced dose apixaban or rivaroxaban over standard dosing7
By vgreene, 12 March, 2021 Prognostic scores D dimer and US to visualize residual DVT not routine for pts w unprovoked VTE but may be useful in select pts
By vgreene, 12 March, 2021 Continue anticoagulation indefinitely in pts w CA assoc DVT PE per ACCP3 ASH 4 per ASCO offer continued tx w LMWH direct factor Xa inhibitor or VKA beyond the initial 6mo to select pts w active CA eg those w metastatic dz or those receiving chemo tx 5
By vgreene, 12 March, 2021 Consider extended no stop date anticoagulation in pts w either unprovoked DVT PE or VTE provoked by chronic risk factor unless high risk of bleeding 1 DOAC preferred over VKA2
By vgreene, 12 March, 2021 In pts requiring continued secondary prevention consider anticoagulants over aspirin per ASH per ACCP if pt w unprovoked PE or proximal DVT stops anticoagulant consider aspirin over no tx at all2
By vgreene, 12 March, 2021 If DVT or PE provoked by transient risk factor eg surgery may d c anticoagulation after primary tx 3 6mo per ASH 3mo per ACCP
By vgreene, 12 March, 2021 Upon conclusion of primary tx decide upon continued long term anticoagulation for secondary prevention of recurrent VTE
By vgreene, 12 March, 2021 Don t insert IVC filter in pts on anticoagulation tx per ACCP per ASCO don t offer IVC filter to pts w established or chronic VTE Dx 4wk prior nor to pts w temp contraindications to anticoagulant tx d t long term harms
By vgreene, 12 March, 2021 Compression stockings may help darr edema pain assoc w acute DVT but unlikely to darr risk of PTS
By vgreene, 12 March, 2021 If pt w stable ASCVD no recent ACS or PCI previously on aspirin for risk reduction Consider suspending aspirin while on anticoagulant tx
