What are the current NICE guidelines for the management of DVT in adults, including anticoagulation options?

For the management of deep vein thrombosis (DVT) in adults, NICE recommends offering anticoagulation treatment for at least 3 months to people with confirmed proximal DVT or PE ¹.

When offering anticoagulation, consider patient comorbidities, contraindications, and preferences, and follow specific guidance for cases such as DVT in people with renal impairment, active cancer, or antiphospholipid syndrome ¹.

First-line anticoagulant options include apixaban or rivaroxaban, which should be offered to people with confirmed proximal DVT or PE, considering individual clinical features ¹.

If apixaban or rivaroxaban are unsuitable, NICE recommends LMWH for at least 5 days followed by dabigatran or edoxaban, or LMWH concurrently with a vitamin K antagonist (VKA) until INR reaches at least 2.0 in two consecutive tests ¹.

Baseline blood tests, including full blood count, renal and hepatic function, PT, and APTT, should be performed when starting anticoagulation, but treatment should not be delayed awaiting results ¹.

In cases of renal impairment, specific options are recommended: for estimated creatinine clearance between 15-50 ml/min, apixaban, rivaroxaban, or LMWH followed by edoxaban or dabigatran; for less than 15 ml/min, LMWH or UFH with VKA are advised ¹.