Venous thrombo embolism

Question 1

Isolated distal DVT/subsegmental PE

Answer 1

Distal DVT is a thrombus in the calf veins. Subsegmental PE are emboli limited to the smaller, subsegmental branches of pulmonary arteries clinical surveillance or 3 months of anticoagulant therapy

Question 2

Transient risk factor

Answer 2

If the transient risk factor is major (surgery) 3 months therapy is indicated, but VTE associated with transient minor (immobilization, travel >8 hours, puerperium or lower limb trauma with impaired mobility) or persistent minor risk factors (inflammatory bowel disease, CHF, BMI >30 kg/m​2, family history of VTE, thrombophilia) may merit extending anticoagulation beyond 3 to 6 months.
Anticoagulation with direct oral anticoagulants (rivaroxaban or apixaban, or initial LMWH followed by dabigatran or edoxaban). Vitamin K antagonists are suggested for those with a ClCr of <30 mL/min and those with concomitant use of P-glycoprotein inhibitors or cytochrome P450 3A4 inhibitors or inducers.

Question 3

Unprovoked

Answer 3

Anticoagulation with direct oral anticoagulants (rivaroxaban or apixaban, or initial LMWH followed by dabigatran or edoxaban). Vitamin K antagonists are suggested for those with a ClCr of <30 mL/min and those with concomitant use of P-glycoprotein inhibitors or cytochrome P450 3A4 inhibitors or inducers.

Question 4

Cancer Associated

Answer 4

6 months of anticoagulant therapy Edoxaban after 1 week of LMWH, or apixaban, or rivaroxaban as solo therapy. Consideration to use LMWH alone when the cancer originates in the gastrointestinal tract.