DVT_Managemenfhhfytertt_Presentation.pptx

dvt

1. Management of Deep Vein Thrombosis (DVT) Based on ESVS 2021 & NICE 2020 Guidelines Presented by: [Your Name]

2. Introduction to DVT Management A silent threat within the veins – DVT management is the key to preventing life-threatening complications. Goals of Management: - Prevent clot extension and embolization - Reduce symptoms and improve quality of life - Minimize long-term complications

3. First-Line Treatment – Anticoagulation Therapy Preferred First-Line Therapy: Direct Oral Anticoagulants (DOACs) - Apixaban (10 mg BID for 7 days, then 5 mg BID) - Rivaroxaban (15 mg BID for 21 days, then 20 mg OD) Alternative Therapy for Special Cases: - LMWH + Warfarin (INR 2-3) - Unfractionated Heparin (UFH) for renal failure or perioperative cases

4. Duration of Therapy – How Long? - Provoked DVT (surgery, trauma, temporary risk factors): 3 months - Unprovoked DVT (idiopathic): ≥3-6 months, reassess for extended therapy - Cancer-associated DVT: LMWH for at least 6 months - Recurrent DVT or ongoing risk factors: Indefinite treatment

5. Thrombolytic Therapy – Dissolving the Clot - What is Thrombolytic Therapy? - Use of fibrinolytic agents to dissolve clots (e.g., Alteplase - tPA) - Indications: - Catheter-Directed Thrombolysis (CDT) for iliofemoral DVT - Reduces risk of Post-Thrombotic Syndrome (PTS) - Contraindications: Active bleeding, recent major surgery/stroke

6. Mechanical Interventions – IVC Filters - Role of Inferior Vena Cava (IVC) Filters: - Used when anticoagulation is contraindicated - Should be removed as soon as possible - Risks: - Increased risk of thrombosis - Device migration or fracture

7. Compression Therapy – Preventing Post-Thrombotic Syndrome - Graduated Compression Stockings (GCS): - Reduces swelling & prevents PTS - Pressure: 30-40 mmHg - Duration: At least 2 years if symptoms persist - Early Mobilization vs. Bed Rest: - Early mobilization preferred over prolonged bed rest

8. Special Populations – Adjusted Management - Pregnancy: - LMWH first-line; DOACs & Warfarin contraindicated - Duration: Until 6 weeks postpartum - Cancer-Associated DVT: - LMWH preferred over DOACs due to lower bleeding risk - Duration: At least 6 months or indefinitely if cancer is active - Elderly & Renal Impairment: - Dose-adjusted DOACs or Warfarin with INR monitoring

9. Long-Term Management & Secondary Prevention - Extended Anticoagulation Therapy: For recurrent DVT/high-risk patients - Low-dose Apixaban or Rivaroxaban for extended prevention - Lifestyle Modifications: Regular activity, weight management, smoking cessation - Patient Education & Follow-Up: - Monitor for bleeding risks - Educate on signs of DVT recurrence or PE

10. Summary – Key Takeaways - DOACs (Apixaban, Rivaroxaban) are first-line treatment - LMWH is preferred for cancer-associated DVT & pregnancy - Thrombolysis reserved for severe iliofemoral DVT cases - IVC filters only when anticoagulation is contraindicated - Compression stockings help prevent post-thrombotic syndrome

11. References - European Society for Vascular Surgery (ESVS) 2021 Guidelines - National Institute for Health and Care Excellence (NICE) 2020 Guideline NG158