VTE management
Anticoagulate all except contraindications. DOAC > VKA (APS: VKA) > LMWH (pregnancy, some GI cancers).
Alberto M. Sobrero5 min6 questions5 trials
Intensity follows hemodynamics
Clot burden on the radiology report does not pick the therapy. , RV strain, and bleeding risk do (ESC PE 2019; CHEST 2021; ).
| Stratum | Definition | Move |
|---|---|---|
| High | or persistent hypotension | Thrombolysis if no contraindication; embolectomy / ECMO / PERT if there is. Heparin drip. |
| Intermediate-high | RV strain + troponin / NT-proBNP, normotensive | Anticoagulate, monitor, PERT. Rescue lysis if they deteriorate. Catheter-directed therapy in selected centers. |
| Intermediate-low | RV strain or biomarker, not both | Anticoagulate. Usually the floor, not the unit. |
| Low | PESI I–II or sPESI 0, no RV strain | DOAC, often home if social situation allows. |
- Most patients: apixaban () or rivaroxaban () without a heparin . Cancer: apixaban (CARAVAGGIO) or LMWH.
- Provoked by a surgical / transient factor: 3 months. Unprovoked or persistent risk: longer, with bleed-risk review.
- Distal DVT: serial ultrasound or 3 months of anticoagulation if symptomatic.
- IVC filters: for acute proximal DVT when anticoagulation is truly impossible — then retrieve them.