A 35-year-old woman presents with unilateral left leg swelling and pain. Wells score for DVT is 3 (active cancer, entire leg swollen, localized tenderness). D-dimer is elevated at 1800 ng/mL. Compression ultrasound shows a non-compressible left common femoral vein. Which anticoagulant is the most appropriate initial therapy?

• A Unfractionated heparin with warfarin bridging
• B Low-molecular-weight heparin (enoxaparin) monotherapy ✓
• C Rivaroxaban monotherapy
• D Aspirin 325 mg daily

Explanation

This is a confirmed proximal DVT in a patient with active cancer. According to ASCO and ASH guidelines, low-molecular-weight heparin (enoxaparin) is the preferred initial and long-term anticoagulation for cancer-associated thrombosis, superior to warfarin. DOACs like rivaroxaban are alternatives but carry higher bleeding risk in gastrointestinal and genitourinary malignancies. Unfractionated heparin is reserved for patients with renal failure or those undergoing intervention. Aspirin is inadequate for acute DVT treatment.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.