Patient handout

Proximal DVT (iliofemoral / popliteal)

PRODUCTION

1. Your condition

This handout is for proximal dvt (iliofemoral / popliteal). Your care team identified this based on: whole-leg swelling, thigh pain, warmth → suggests proximal (iliofemoral) dvt (wells lancet 1997).

Other reasons your team may use this plan: compression us shows non-compressible femoral or popliteal vein → proximal dvt confirmed; massive iliofemoral dvt with cyanosis, severe edema, compromised arterial inflow → limb-threatening; cdt/thrombectomy emergency.

2. Your medications

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 × ≥3 months	AMPLIFY (Agnelli NEJM 2013 PMID 23808982) — non-inferior to LMWH/warfarin with less major bleed; ACCP 2021 first-line
rivaroxaban	15 mg BID × 21 d → 20 mg daily with food	PO	BID then daily × ≥3 months	EINSTEIN-DVT (Bauersachs NEJM 2010 PMID 21128814) — non-inferior to enoxaparin/VKA; single-drug regimen
edoxaban	60 mg daily after 5 d LMWH lead-in (30 mg if CrCl 15-50 or weight ≤60 kg)	PO	daily × ≥3 months	Hokusai-VTE (Büller NEJM 2013 PMID 23991958) — non-inferior to warfarin with less bleed
enoxaparin	1 mg/kg SC BID (or 1.5 mg/kg daily); dose-reduce if CrCl <30 to 1 mg/kg daily	SC	BID	ASH 2018 VTE in Pregnancy (Bates PMID 30482767); ACCP 2021 LMWH preferred in pregnancy and select renal/comorbid scenarios
warfarin	5 mg daily; INR target 2-3	PO	daily	TRAPS (Pengo Blood 2018 PMID 30002145) — warfarin preferred over rivaroxaban in triple-positive APS

Plan: Proximal DVT full-dose anticoagulation — DOAC-first per ACCP 2021 / ASH 2020

3. When to call your provider

Contact your care team if any of the following happen:

New cancer dx → re-evaluate per cancer-VTE protocol
New pregnancy plan → switch to LMWH

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Massive iliofemoral DVT with cyanosis, severe edema, compromised arterial inflow → limb-threatening(life-threatening)
DVT extension into IVC or progression of iliac thrombus despite therapeutic AC
Major bleed on catheter-directed thrombolysis (Hgb drop ≥2 g/dL, transfusion required, ICH, retroperitoneal)(life-threatening)
Proximal DVT + concurrent PE with hypotension or shock (massive PE)(life-threatening)

5. Follow-up

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

6. Sources

Guideline: ACCP/CHEST 2021 Antithrombotic + ASH 2020 VTE Treatment + ESC 2019 PE