Is This Case of Deep Vein Thrombosis Provoked or Unprovoked?

Here’s how readers responded to a You Make the Call question about travel-related deep vein thrombosis.


Disclaimer: ASH does not recommend or endorse any specific tests, physicians, products, procedures, or opinions, and disclaims any representation, warranty, or guaranty as to the same. Reliance on any information provided in this article is solely at your own risk.


For provoked DVT, three months of anticoagulation, then check D-dimers one month later. If unprovoked, six months of treatment, then check D-dimers one month later. If elevated, continue treatment. Thrombophilia work-up?

Maurice C. Schwarz, MD
Virginia Cancer Institute
Mechanicsville, VA

 

I would consider this a provoked episode even though the periods of decreased mobility were not continuous. Therefore, the duration of treatment should be three months.

Vincent Louis Naicker, MD
University of KwaZulu-Natal
Durban, South Africa 

I consider this a provoked event, so I would initially treat her for at least three months, but I prefer an echo Doppler and serial D-dimers to stop treatment.

Paola Turcatti, MD
Montevideo, Uruguay

Provoked. Three months. I would not do D-dimers and would consider aspirin after anticoagulation. Warn patient about signs of DVT when anticoagulation stops.

Arunabh Sekhri, MD
Mayo Clinic
Mankato, MN

 

I consider this unprovoked, as she might have an underlying thrombophilia. She needs six months of treatment depending on follow-up D-dimer results.

Saifudeen, MBBS, MD
Sultan Qaboos Hospital
Salalah, Oman

It’s provoked DVT.

Smitha Mellacheruvu, MD
Montefiore Medical Center
New York, NY

 She had a provoked DVT, and I suggest three months of anticoagulation without checking D-dimers. I would inquire about family history of venous thromboembolic events and would also discuss the merits of a thrombophilia work-up.

Juan M. Alcantar, MD
UCLA Health
Los Angeles, CA

I consider this unprovoked (less than 8-hour flight). I suggest D-dimers at three months.

William Caceres, MD
San Juan VA Medical Center
Río Piedras, Puerto Rico

I’d call it provoked, and I’d consider oral anticoagulation for three months.

Michael Steurer, MD
Medical University of Innsbruck
Innsbruck, Austria

Unprovoked.

Larry A. Otteman, MD
McFarland Clinic
Ames, IA

I would manage this as an unprovoked DVT and consider three months of initial anticoagulation. She needs to be reassessed with D-dimers. If they are abnormal, she is at risk of recurrence and needs long-term anticoagulation with regular assessment for bleeding risk. The duration of anticoagulation will depend on the risk of bleeding and the clinical decision regarding regular follow-up.

Polwattha Koralalage Lorani Inosha, MD
Colombo, Sri Lanka

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