This handout is for dvt/vte in behçet's disease (variable-vessel vasculitis). Your care team identified this based on: unilateral leg swelling with proven dvt in patient with recurrent oral aphthae + genital ulcers ± uveitis — pretest probability for vascular behçet is high (isg / icbd criteria).
Other reasons your team may use this plan: vte in young (under 40) male of turkish, iranian, mediterranean, or central/east asian descent — prompts behçet workup; hla-b51 association; recurrent dvt with elevated crp/esr + ocular inflammation or skin pathergy — vasculitic vte should be considered; cerebral venous sinus thrombosis on mr-venography in young patient with mucocutaneous ulcers — behçet cvst workup pathway.
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| apixaban | 10 mg BID × 7 d → 5 mg BID | PO | BID indefinite while disease active | AMPLIFY (Agnelli NEJM 2013 PMID 23808982); ACCP 2021; small Behçet case series support DOAC use for routine peripheral DVT |
| rivaroxaban | 15 mg BID × 21 d → 20 mg daily | PO | BID then daily indefinite while disease active | EINSTEIN-DVT (Bauersachs NEJM 2010 PMID 21128814); alternative DOAC |
| enoxaparin | 1 mg/kg SC BID; reduce to 1 mg/kg daily if CrCl <30 | SC | BID | ASH 2020 (PMID 33007077); ACCP 2021 — LMWH bridge for inpatient stabilisation and pregnancy |
| warfarin | 5 mg daily; INR target 2-3 (target 3 if triple-positive APS coexists) | PO | daily indefinite while disease active | Easier reversibility for vasculitis flares requiring procedures; preferred when concurrent triple-positive APS |
| azathioprine | 2-3 mg/kg/day PO (TPMT-guided dosing — start lower if intermediate activity) | PO | daily indefinite while disease active | EULAR 2018 (Hatemi PMID 29945920) Class I — azathioprine reduces VTE recurrence dramatically vs AC alone (Saadoun cohort) |
| prednisone | 1 mg/kg/day PO (max 60-80 mg) tapering over weeks-months as immunosuppression takes effect | PO | daily, tapering | EULAR 2018 — co-administered glucocorticoid for induction; methylprednisolone 1 g IV × 3 d for severe / sight-threatening |
| cyclophosphamide | 500-1000 mg/m² IV monthly × 6 mo (NIH protocol) or 2 mg/kg/day PO | IV or PO | monthly × 6 mo | EULAR 2018 — cyclophosphamide first-line for severe vascular Behçet (vena cava, CVST, pulmonary aneurysm); monitor for hemorrhagic cystitis (mesna), bone marrow suppression, infertility |
| infliximab | 5 mg/kg IV at 0, 2, 6 weeks then every 8 weeks | IV | q8 weeks maintenance | EULAR 2018 — TNF-α inhibitors for refractory or sight-threatening Behçet; ACR/VF 2021 strong recommendation; pre-treatment TB and hepatitis screening required |
| adalimumab | 40 mg SC every 2 weeks (or weekly for severe disease) | SC | q2 weeks | Alternative TNF-α inhibitor with similar efficacy in vascular Behçet (case series + extension trials) |
| colchicine | 0.6 mg PO BID-TID | PO | BID-TID indefinite | EULAR 2018 — first-line for mucocutaneous manifestations; baseline anti-inflammatory adjunct in vascular disease |
Plan: Behçet's vascular VTE — anticoagulation co-administered with immunosuppression (EULAR 2018; ACR/VF 2021; Saadoun cohort)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Long-term rheumatology + cardiology + ophthalmology multidisciplinary care; AC continuation reviewed annually with disease activity; immunosuppression taper as remission achieved; family planning counseling (azathioprine compatible with pregnancy, cyclophosphamide is gonadotoxic — preserve fertility before treatment); vaccinations updated before biologics
Guideline: EULAR 2018 Behçet Disease (Hatemi) + ACR/Vasculitis Foundation 2021 Behçet + ACCP/CHEST 2021 (Stevens) for AC duration