For long-term management of deep vein thrombosis, which therapy is preferred?

• A. Heparin therapy
• B. Warfarin therapy alone
• C. DOACs such as apixaban or rivaroxaban
• D. Aspirin therapy only

Answer: (C)

Direct oral anticoagulants, such as apixaban or rivaroxaban, are preferred for long-term management of deep vein thrombosis. They provide effective protection against recurrent events with a convenient, fixed dosing approach and do not require routine lab monitoring or warfarin-like INR management. They also avoid the need for bridging with heparin, which simplifies outpatient therapy. Trials have shown these DOACs to be as effective as warfarin for preventing recurrence, with at least comparable or even lower risk of major bleeding. In contrast, heparin is mainly for initial treatment, warfarin requires regular INR checks and has many interactions, and aspirin alone does not offer adequate anticoagulation for long-term prevention in most patients.