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Textbook/Haematology and transfusion/Deep-vein thrombosis/Rapid
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Deep-vein thrombosis

Essential points for quick revision.

2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Phlegmasia or associated pulmonary embolism

A massively swollen painful cyanotic limb, sensory or motor deficit, absent pulses, shock, syncope, severe breathlessness, hypoxaemia or chest pain suggests limb-threatening venous obstruction or pulmonary embolism.

Action: Use ABCDE, obtain urgent vascular and haematology input, start therapeutic anticoagulation unless contraindicated, arrange immediate whole-limb vascular imaging and PE assessment as indicated, elevate the limb without compression when arterial supply is uncertain, and assess urgently for catheter-directed thrombus removal, thrombectomy or reperfusion rather than following a routine outpatient sequence.

Synopsis

Use the NICE probability, D-dimer and ultrasound sequence to diagnose deep-vein thrombosis, start correctly dosed anticoagulation promptly, and individualise duration through provoking, recurrence, bleeding, cancer, APS and pregnancy risk.

  • DVT commonly causes unilateral swelling, pain, pitting oedema, warmth and superficial collateral veins, but examination cannot confirm or exclude it; calculate the two-level DVT Wells score.
  • DVT likely means Wells score 2 or more: arrange proximal leg-vein ultrasound within 4 hours where possible and obtain D-dimer if ultrasound is negative.
  • DVT unlikely means Wells score 1 or less: obtain D-dimer first; a negative appropriately interpreted test excludes DVT, while a positive result leads to ultrasound.

Key red flags

Cyanosis, severe tense swelling, blistering, neurological deficit or reduced arterial signals suggests phlegmasia cerulea dolens and threatened venous gangrene.

Threatened limb

Extreme pain, cyanosis, massive swelling, sensory loss or reduced pulses indicates phlegmasia and demands immediate vascular escalation.

Investigation priorities

01
First-line: two-level DVT Wells scoreFirst stepFirst line

Choose ultrasound-first or D-dimer-first testing and avoid unstructured probability estimates.

02
First-line in unlikely DVT: D-dimerFirst line

Exclude thrombosis safely when clinical probability is low.

Management branches

DVT likelyUltrasound before D-dimer

The two-level DVT Wells score is 2 or more.

  1. Arrange proximal leg-vein ultrasound within 4 hours where possible and give interim therapeutic anticoagulation if imaging will be delayed.
  2. Treat a positive scan as confirmed DVT; if negative, obtain D-dimer and stop interim anticoagulation when the pathway excludes thrombosis.

Key medicines

ApixabanGive 10 mg orally twice daily for the first 7 days, then 5 mg twice daily; treat for at least 3 months and, if extended prevention is chosen after 6 months, consider 2.5 mg twice daily according to recurrence and bleeding risk.
RivaroxabanGive 15 mg orally twice daily with food for 21 days, then 20 mg once daily with food; after at least 6 months, 10 mg once daily may be used for selected extended prevention, with 20 mg retained when recurrence risk is high.
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Sources and review status5 sources · checked 27 Aug 2026 · clinical review pending
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom