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Proximal DVT Treatment — RACP Adult Medicine MCQ

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EasyHaematologyProximal DVT TreatmentRACP Adult Medicine

A 55-year-old man with type 2 diabetes presents with a painful swollen right calf. He was recently discharged after hip replacement surgery 10 days ago. D-dimer is elevated. Compression ultrasound shows non-compressibility of the right popliteal vein with absent flow. What is the most appropriate initial treatment?

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Correct answer: D — Rivaroxaban 15 mg BD for 21 days then 20 mg daily

Provoked proximal DVT (post-surgical) requires therapeutic anticoagulation. DOACs (rivaroxaban, apixaban) are now first-line over LMWH-to-warfarin for most DVTs. Rivaroxaban uses a lead-in higher dose (15 mg BD × 21 days then 20 mg daily). Apixaban alternative is 10 mg BD × 7 days then 5 mg BD. Duration is 3 months for provoked DVT.

Reference: eTG Haematology – 2024 – VTE Treatment; ASH 2020; CHEST 2024