🩺 General MedicineCardiovascular / RespiratoryStudentInternResident

Venous Thromboembolism (DVT & PE)

Also known as: VTE · DVT · deep vein thrombosis · pulmonary embolism · PE · blood clot

A clot in the deep veins (DVT) that can embolise to the lungs (PE). Suspect, risk-score, confirm, and anticoagulate; a massive PE with shock needs thrombolysis.

Source · Reviewed 2026-08-15 · v1.0— AI-assisted draft — verify against the cited guideline before clinical use.

⚕️ Education only — not medical advice. Verify against the latest official guideline and your local protocol; confirm every drug dose against the cited source before clinical use.

Who gets it

Immobility, surgery, cancer, pregnancy/postpartum, oestrogen (pill/HRT), long-distance travel, thrombophilia and a prior VTE.

Red flags — escalate / refer

PE with haemodynamic instability (hypotension, shock, syncope) → massive PE: consider thrombolysis.
Hypoxia and right-heart strain indicate a significant PE.

Work-up / diagnosis

1DVT: leg pain/swelling — use a Wells score → D-dimer and/or compression ultrasound.
2PE: dyspnoea, pleuritic pain, tachycardia — Wells/PERC → D-dimer and/or CT pulmonary angiography (V/Q if CTPA contraindicated).
3ECG/CXR support the diagnosis and exclude mimics.

Management — overview

Start anticoagulation once VTE is confirmed (or empirically if high probability and low bleeding risk).
First-line: a direct oral anticoagulant (DOAC); alternatives are LMWH then warfarin (LMWH preferred in cancer and pregnancy).
Massive PE with shock: reperfusion (systemic thrombolysis, or embolectomy if thrombolysis is contraindicated).
Duration by provocation: ~3 months if provoked/reversible; longer/indefinite if unprovoked or ongoing risk (e.g. cancer). Give VTE prophylaxis to at-risk inpatients.

In-depthFull dosing & advanced protocol

Drug dosing

DOAC (e.g. apixaban / rivaroxaban)

First-line anticoagulation

Adult dose: Per product (initial higher-dose lead-in for some agents)
Route: Oral

Caution: Assess bleeding risk; avoid DOACs in pregnancy (use LMWH).

WHOWHO Model List of Essential Medicines (electronic EML) (2025 (24th)) ↗

LMWH (enoxaparin)

Initial/bridging; preferred in cancer & pregnancy

Adult dose: Weight-based subcutaneous
Route: Subcutaneous

WHOWHO Model List of Essential Medicines (electronic EML) (2025 (24th)) ↗

Thrombolysis (e.g. alteplase)

Massive PE with shock

Adult dose: Per protocol; screen contraindications
Route: Intravenous

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

Scoring, special groups & duration

Wells/PERC and age-adjusted D-dimer refine the need for imaging.
Cancer-associated and pregnancy VTE: prefer LMWH (or specific DOAC guidance for cancer).
Decide duration by provoked vs unprovoked; investigate unprovoked VTE and consider an IVC filter only if anticoagulation is contraindicated.

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

References

Guidelines change. If something here is out of date, tell us — we keep these current.

🚩 Report outdated / suggest update

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👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

DOAC (e.g. apixaban / rivaroxaban)

LMWH (enoxaparin)

Thrombolysis (e.g. alteplase)

📈 Scoring, special groups & duration

📚 References

More protocols

👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

DOAC (e.g. apixaban / rivaroxaban)

LMWH (enoxaparin)

Thrombolysis (e.g. alteplase)

📈 Scoring, special groups & duration

📚 References

More protocols

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Scoring, special groups & duration

References

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Scoring, special groups & duration

References