This handout is for distal dvt (isolated calf vein). Your care team identified this based on: isolated calf pain, swelling, tenderness without thigh involvement → suggests distal dvt.
Other reasons your team may use this plan: compression us shows non-compressible distal vein (peroneal, posterior tibial, soleal) with patent popliteal/femoral → isolated distal dvt (iddvt); whole-leg compression us identifies isolated distal dvt not detected by proximal-only protocol (bernardi 2008).
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 × 6-12 weeks | AMPLIFY (PMID 23808982) for full-dose efficacy; ACCP 2021 supports DOAC for IDDVT requiring AC |
| rivaroxaban | 15 mg BID × 21 d → 20 mg daily | PO | BID then daily × 6-12 weeks | EINSTEIN-DVT PMID 21128814 — non-inferior to standard care |
| enoxaparin | 1 mg/kg SC BID | SC | BID | LMWH preferred in pregnancy and select cancer-VTE per CARAVAGGIO PMID 32223112 |
Plan: Isolated distal DVT — AC vs surveillance decision (ACCP 2021)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
AC pathway: stop at 6-12 weeks if provoked + transient risk; consider extended only if extension or unprovoked + high recurrence risk. Surveillance pathway: convert to proximal pathway if extension
Guideline: ACCP/CHEST 2021 Antithrombotic + ASH 2020 VTE Treatment