Patient handout

Venous thromboembolism — DVT + PE (diagnosis, anticoagulation, duration)

PRODUCTION

1. Your condition

This handout is for venous thromboembolism — dvt + pe (diagnosis, anticoagulation, duration). Your care team identified this based on: unilateral leg swelling + calf pain suggesting dvt — wells dvt score + compression ultrasound (ash 2018 dx pmid 30482764).

Other reasons your team may use this plan: pleuritic chest pain + dyspnea ± hemoptysis suggesting pe — wells pe / perc / age-adjusted d-dimer / ctpa (ash 2018 dx; esc 2019 pe pmid 31504429); syncope with hypoxia / tachycardia / rv strain — high-risk pe workup with bedside echo (esc 2019 pmid 31504429); incidental pe on staging or surveillance ct — treat as symptomatic pe (chest 2021 pmid 34352278).

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 PO BID x 7 days, then 5 mg PO BID	PO	BID	AMPLIFY (Agnelli NEJM 2013 PMID 23808982): apixaban non-inferior to enoxaparin/warfarin for recurrent VTE/death with significantly less major bleeding (0.6% vs 1.8%, RR 0.31). No parenteral lead-in. Lowest GI bleed of DOACs.

Plan: Anticoagulation initiation for VTE — non-cancer, non-pregnancy — ASH 2020 PMID 33007077; CHEST 2021 PMID 34352278

3. When to call your provider

Contact your care team if any of the following happen:

Suspected recurrent VTE → imaging + assess compliance + consider LMWH switch — ASH 2020
Major bleeding → ED for reversal — ANNEXA-4
CrCl decline below dosing threshold → switch agent — ASH 2020
Pregnancy detected → switch DOAC/warfarin to LMWH immediately — CHEST 2021

4. When to seek emergency care

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

Confirmed PE with sustained SBP <90 for ≥15 min, vasopressor requirement, or cardiac arrest — ESC 2019(life-threatening)
Massive ileofemoral DVT with cyanotic ischemic limb (phlegmasia cerulea dolens) — limb-threatening(life-threatening)
Intermediate-high-risk PE (sPESI ≥1 + RV dysfunction + elevated cardiac biomarker) with clinical decompensation (worsening hypotension, hypoxia, tachycardia) — ESC 2019
Pregnant patient with suspected or confirmed PE and oxygen level (SpO₂) <94% or hemodynamic compromise — CHEST 2021
Major bleeding (GI, ICH, retroperitoneal, hemodynamically significant) on anticoagulation for VTE — ANNEXA-4 + RE-VERSE AD(life-threatening)
GI bleeding in patient with cancer-associated VTE on DOAC (especially rivaroxaban or edoxaban with luminal-GI primary) — SELECT-D + Hokusai cancer

5. Follow-up

Duration at 3 mo per CHEST 2021 PMID 34352278: PROVOKED VTE (transient major risk factor — surgery, hospitalization, trauma within 3 mo) → STOP at 3 mo; UNPROVOKED VTE → consider INDEFINITE (especially male, recurrent, persistent D-dimer positivity); CANCER-associated → continue until cancer resolved or anticoagulation no longer tolerated; RECURRENT unprovoked → INDEFINITE; ANTIPHOSPHOLIPID syndrome triple-positive → INDEFINITE warfarin. AMPLIFY-EXT PMID 23216615 supports apixaban 2.5 mg BID for extended treatment with similar efficacy and lower bleeding vs 5 mg BID. Annual reassessment of indication, bleeding risk (HAS-BLED), renal function. Patient education on bleeding precautions, dietary consistency (warfarin), missed-dose handling, medical-alert ID

6. Sources

Guideline: ASH 2018 VTE diagnosis (Lim Blood Adv 2018) + ASH 2020 VTE treatment (Ortel Blood Adv 2020) + CHEST 2021 antithrombotic update (Stevens Chest 2021) + ESC 2019 PE guidelines (Konstantinides Eur Heart J 2020)