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cardio.dvt.proximal.v1

Proximal DVT (iliofemoral / popliteal)

cardiologyacuteadultacuteinpatienttransitionoutpatient
Start encounter →Print handoutPRODUCTION

Phase E variant of cardio.dvt.core.v1 — narrowed to proximal (iliofemoral / popliteal) DVT. Inherits diagnostic arc (Wells + age-adjusted D-dimer + whole-leg compression US) and DOAC-first chronic regimen from parent via routing; specializes for iliofemoral severity (CDT consideration per ATTRACT subgroup + CaVenT), full-dose AC ≥3 months minimum, PTS prevention strategy, and IVC filter restraint per PREPIC2. Manifest pointer reuses cardio.dvt.core.v1 manifest. Design-brief pointer reuses parent (proximal-specific differences documented inline). Status INTEGRATED until terminology + RxNav-validated drug codes are reconciled. Authored 2026-05-14 by shard-06-cardio-acute as proximal-DVT variant.

Entry points (3)

  • symptom
    Whole-leg swelling, thigh pain, warmth → suggests proximal (iliofemoral) DVT (Wells Lancet 1997)
    iliofemoral_swelling_pain
  • imaging
    Compression US shows non-compressible femoral or popliteal vein → proximal DVT confirmed
    us_proximal_thrombus
  • symptom
    Massive iliofemoral DVT with cyanosis, severe edema, compromised arterial inflow → limb-threatening; CDT/thrombectomy emergency
    phlegmasia_cerulea_dolens

Required inputs (7)

  • agerequired
    demographic • used at CONTEXT
    Older patients higher recurrence and bleed risk; informs extended-AC decision
  • leg_swellingrequired
    symptom • used at ENTRY
    Whole-leg vs calf-only distribution differentiates proximal vs distal DVT
  • compression_usrequired
    imaging • used at INITIAL_WORKUP
    Non-compressible femoral/popliteal vein confirms proximal DVT; Bernardi JAMA 2008 single-time whole-leg US strategy (PMID 18272884)
  • creatininerequired
    lab • used at TREATMENT
    eGFR for DOAC dosing; CKD-EPI 2021 race-free preferred
  • cbcrequired
    lab • used at INITIAL_WORKUP
    Baseline Hgb + platelet for AC + bleed risk assessment
  • provoked_statusrequired
    history • used at CONTEXT
    Provoked vs unprovoked status drives 3-month vs extended AC duration decision
  • bleed_riskrequired
    history • used at RED_FLAGS
    HAS-BLED + recent surgery + falls history determines AC eligibility and CDT candidacy

12-phase flow (10)

  1. 1FRAME
    Proximal DVT = thrombus at or above popliteal vein; full-dose AC ≥3 months minimum; high CDT-eligibility for iliofemoral; route to cardio.dvt.core.v1 for diagnostic arc
    inputs: leg_swelling
    advance: proximal location confirmed on imaging
  2. 2ENTRY
    Wells score → US directly if high pretest probability; age-adjusted D-dimer if intermediate
    inputs: age
    advance: pretest probability assigned
  3. 3CONTEXT
    Provoked vs unprovoked, transient vs persistent risk; cancer screen; pregnancy status; APS antiphospholipid screen if young or recurrent
    inputs: provoked_status, creatinine
    advance: provoking factor classified
  4. 4RED_FLAGS
    Phlegmasia cerulea dolens (limb-threatening); massive iliofemoral with severe symptoms <14 d (CDT consideration); concurrent PE; absolute AC contraindication (active bleed)
    inputs: bleed_risk
    actions: phlegmasia_pathway, concurrent_pe_screen
    advance: limb-threatening features screened
  5. 5INITIAL_WORKUP
    Whole-leg compression US (Bernardi 2008); CBC + BMP + INR/PTT; D-dimer if pretest probability low-intermediate
    inputs: compression_us, cbc, creatinine
    actions: panel.cardiac, panel.renal
    advance: imaging confirms proximal DVT
  6. 6BRANCHING_WORKUP
    Iliofemoral severity assessment for CDT eligibility (ATTRACT subgroup); IVC compression vs May-Thurner anatomy if iliac DVT (consider venogram + stent); thrombophilia testing only if recurrent or strong family hx (ASH 2023)
    advance: CDT vs AC-only decision documented
  7. 7TREATMENT
    Standard DOAC-first regimen: rivaroxaban 15 mg BID × 21d → 20 mg daily, OR apixaban 10 mg BID × 7d → 5 mg BID; full duration ≥3 months minimum (ACCP 2021); CDT for severe iliofemoral within 14 d if bleed risk acceptable (ATTRACT subgroup; CaVenT)
    inputs: creatinine, bleed_risk
    advance: AC initiated and CDT decision documented
  8. 8DISPOSITION
    Outpatient if hemodynamically stable on oral AC; inpatient for CDT, phlegmasia, severe pain, or bleed risk; ICU for phlegmasia/CDT
    advance: unit assigned + AC plan documented
  9. 9MONITORING
    Bleeding screen at each visit; CBC + BMP at week 1 then monthly; PTS surveillance at 3-6 mo (Villalta scale); recurrent VTE symptoms
    actions: panel.cardiac
    advance: bleed + PTS monitoring plan documented
  10. 10FOLLOWUP
    3-month decision: stop AC if provoked + transient major risk resolved; continue extended (reduced dose) if unprovoked or persistent risk; HERDOO2/DASH for risk stratification
    advance: extended-AC vs stop decision documented