Management of DVT

1) Diagnosis of DVT by:

1. Clinical Probability (Hx, PE)
2. U/S Doppler
3. D- Dimer 

2) Management of DVT (Hep-Warfarin Therapy)

1. Exclude Pul Embolism; Clinical: Hemoptysis, Tachycardia, Ix: ECG, CXR, ABG, CTPA
2. Blood Ix (for DVT) : FBC, PT/APTT, baseline INR & APTT ratio, Thrombophilia Screening 
3. Start Heparin
• UFH - Loading dose 5000 U bolus, then 1000 U/HR by IVI, Monitor APTT ratio 6 HRly aim 2-3 (and change accordingly)
• LMWH - No need monitoring (give S/C)
4. START Warfarin D2 (aim INR: 2-3)
5. STOP Heparin when INR > 2 x 2 consecutive days (Combination of Hep-Warfarin at least 5 days)
6. Take DAILY INR for 1st week
7. Maintenance Dose Warfarin ~ 2-10 mg/d
8. Duration of Warfarin:

• Idiopathic: 6 month
• Recurrent: 6 month - 1 yr  

3) Find Underlying Causes 

4) Combined with Mechanical Tx of DVT

• TED Stocking : minimize post-thrombotic event 
• PhysioTx/ Encourage Mobility