Synopsis
Treat confirmed haemodynamically stable PE with the right anticoagulant, dose, duration and follow-up plan while recognising patients who need admission, a different drug strategy or urgent escalation.
- For confirmed proximal DVT or PE, NICE recommends therapeutic anticoagulation for at least 3 months.
- For most haemodynamically stable adults, offer apixaban or rivaroxaban if suitable; each has a mandatory higher-dose initial phase.
- Apixaban: 10 mg twice daily for 7 days, then 5 mg twice daily. Rivaroxaban: 15 mg twice daily for 21 days, then 20 mg once daily with food.
Key red flags
Active major bleeding, recent high-risk surgery, severe thrombocytopenia, intracranial pathology or another major haemorrhage risk requires senior haematology/specialty discussion and sometimes a temporary IVC filter.
Investigation priorities
Identify anaemia, thrombocytopenia and a baseline for bleeding/HIT surveillance.
Management branches
Confirmed PE, haemodynamically stable, no major contraindication and apixaban/rivaroxaban suitable.
- Document baseline FBC, renal/liver function, coagulation, weight, bleeding risk, interactions and pregnancy status where relevant.
- Start either apixaban 10 mg twice daily for 7 days then 5 mg twice daily, or rivaroxaban 15 mg twice daily for 21 days then 20 mg once daily with food; prescribe the transition date explicitly.
Key medicines
Apixaban10 mg orally twice daily for 7 days, then 5 mg twice daily; if extended prevention is chosen after 6 months, the licensed prevention dose is 2.5 mg twice daily.
Rivaroxaban15 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 is licensed for extended prevention, with 20 mg considered when recurrence risk is high.