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Distal DVT Management — RACP Adult Medicine MCQ

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ModerateHaematologyDistal DVT ManagementRACP Adult Medicine

A 35-year-old man presents with a swollen right calf after a long-haul flight. Doppler ultrasound confirms a distal (below-knee) DVT confined to the posterior tibial vein. He has no prior VTE history, no cancer, and no other risk factors. What is the recommended management?

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Correct answer: C — Surveillance with serial ultrasound over 2 weeks

For isolated distal (calf) DVT with a clear provoking factor and no risk factors for extension, serial ultrasound surveillance over 2 weeks (to confirm non-propagation) is an acceptable alternative to anticoagulation. If the clot extends proximally (above the popliteal vein), anticoagulation is indicated. Full anticoagulation for 3 months is recommended if the patient has cancer, unprovoked DVT, severe symptoms, or proximal extension on surveillance imaging. This conservative approach avoids unnecessary anticoagulation for a low-risk clot.

Reference: eTG – 2025 – Haematology; ACCP – 2021 – VTE Guidelines