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MS – DVT Management — SCE Neurology MCQ

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ModerateMultiple Sclerosis & CNS InflammationMS – DVT ManagementSCE Neurology

A 55-year-old man with long-standing MS (EDSS 7.5, wheelchair-dependent) develops a painful, red, swollen left calf. He has been relatively immobile for 3 months. D-dimer is elevated. CT pulmonary angiography shows no PE. Doppler ultrasound confirms a left popliteal DVT. He has no contraindications to anticoagulation. What is the recommended treatment?

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Correct answer: C — Therapeutic-dose LMWH followed by a DOAC for at least 3 months

DVT in MS patients (who are at increased risk due to immobility) is treated with standard anticoagulation per NICE NG158. This typically involves therapeutic-dose LMWH acutely, followed by a DOAC (apixaban or rivaroxaban — which can be started without LMWH lead-in for apixaban) for at least 3 months. Warfarin is an alternative but DOACs are preferred. Compression stockings alone are insufficient. VTE prophylaxis should be considered in all immobile MS patients. A: Aspirin is not adequate for DVT treatment. C: Stockings alone are insufficient. D: IVC filter is for recurrent PE despite anticoagulation. E: Warfarin is acceptable but DOACs are now preferred.

Reference: NICE NG158 VTE Treatment (2020)