Executive summary
- Algorithm: 2-level Wells Score determines the path (Likely vs Unlikely).
- Interim cover: If scan delayed >4 hours, give DOAC stat (e.g., Apixaban 10mg or Rivaroxaban 15mg).
- Treatment: DOACs are first line for almost all patients (including most Cancer-associated VTE).
Diagnostic Pathway (DVT)
- Wells Score ≥ 2 (Likely):
- Refer for Proximal Leg Ultrasound (scan within 4h).
- If delay >4h: D-dimer + Interim Anticoagulation (Apixaban/Rivaroxaban).
- Wells Score ≤ 1 (Unlikely):
- Perform D-dimer.
- Positive: Scan + Interim Anticoagulation.
- Negative: DVT excluded (consider alternative diagnosis).
Treatment Regimens
- Apixaban (Eliquis):
- Loading: 10mg bd for 7 days.
- Maintenance: 5mg bd thereafter. (Reduce to 2.5mg bd after 6 months for prophylaxis if indicated).
- Rivaroxaban (Xarelto):
- Loading: 15mg bd for 21 days (Take with food).
- Maintenance: 20mg od thereafter.
- Duration:
- Provoked (Surgery/Trauma): 3 months (then stop).
- Unprovoked: 3 months, then review. usually continue long-term unless bleeding risk > recurrence risk.
- Cancer-Associated: 3-6 months (DOAC preferred over LMWH unless GI cancer/urothelial cancer where bleeding risk is high).
Transparency
This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.