Bilateral Renal Vein Thrombosis Thrombophilia — ESENeph MCQ

Correct answer: E — Start LMWH with an overlapping vitamin K antagonist

The best answer is “Start LMWH with an overlapping vitamin K antagonist”. NICE advises LMWH concurrently with a VKA for at least 5 days and until INR is at least 2.0 on 2 consecutive readings, followed by the VKA alone. “Start rivaroxaban as single-agent treatment” is less appropriate because triple-positive antiphospholipid syndrome has a specific VKA-based pathway because recurrent thrombosis is higher with direct oral anticoagulants “Give LMWH for 48 hours and then stop anticoagulation” is less appropriate because this neither establishes therapeutic VKA anticoagulation nor treats the DVT for an adequate duration “Start aspirin with a vitamin K antagonist without heparin overlap” is less appropriate because aspirin does not provide the required immediate therapeutic anticoagulation while the VKA becomes effective “Use unfractionated heparin indefinitely without reassessment” is less appropriate because the NICE triple-positive APS pathway transitions to a VKA after adequate parenteral overlap

Reference: NICE NG158: venous thromboembolic diseases: https://www.nice.org.uk/guidance/ng158/chapter/Recommendations