Thromboembolic Disorder Treatments: DVT/PE
|THROMBOEMBOLIC DISORDER TREATMENTS: DVT/PE|
|warfarin||Coumadin||tabs||Prophylaxis and treatment of DVT or PE||Individualize. Initially 2−5mg daily. Usual maintenance: 2−10mg daily. CYP2C9 or VKORC1 enzymes variations, elderly, debilitated, Asians: use lower initial and maintenance doses.|
|Direct Thrombin Inhibitors|
|dabigatran||Pradaxa||caps||DVT/PE treatment in those treated with parenteral anticoagulant for 5−10 days. Reduce risk of recurrent DVT/PE in those that have been previously treated.||CrCl>30mL/min: 150mg twice daily (if treatment, give after 5−10 days of parenteral anticoagulation). CrCl ≤30mL/min or on dialysis: not recommended. CrCl <50mL/min with concomitant P-gp inhibitors: avoid.|
|DVT/PE prophylaxis after hip replacement surgery||CrCl>30mL/min: 110mg for first day (given 1−4hrs post surgery and after hemostasis achieved), then 220mg daily for 28−35 days. CrCl ≤30mL/min or on dialysis: not recommended. CrCl <50mL/min with concomitant P-gp inhibitors: avoid.|
|desirudin||Iprivask||inj||DVT prophylaxis – hip replacement surgery||15mg SC inj (preferably in the abdomen or thigh) every 12hrs starting up to 5−15min before surgery (after induction of regional block anesthesia, if used); may continue for 9−12 days post‑op.|
|Factor Xa Inhibitors|
|apixaban||Eliquis||tabs||DVT prophylaxis if underwent hip or knee replacement surgery||2.5mg twice daily; initially give 12−24hrs after surgery. Hip: treat for 35 days. Knee: treat for 12 days.|
|DVT, PE treatment||10mg twice daily for 7 days, then 5mg twice daily|
|Reduce risk of DVT, PE recurrence||2.5mg twice daily after at least 6 months of DVT or PE treatment|
|betrixaban||Bevyxxa||caps||VTE prophylaxis – hospitalized patients||Initially 160mg as a single dose, then 80mg once daily for 35–42 days.|
|Arixtra||inj||DVT prophylaxis – abdominal surgery; hip replacement or fracture surgery; knee replacement||2.5mg SC once daily (after hemostasis is established, no earlier than 6−8hrs post‑op) for 5−9 days. Abdominal: max 10 days. Hip or knee replacement: max 11 days. Hip fracture: give for up to 24 more days (max 32 days total).|
|Acute DVT or PE (with warfarin)||<50kg: 5mg; 50−100kg: 7.5mg; >100kg: 10mg; for all: give SC once daily for at least 5 days (usually 5−9 days; max 26 days) until adequately anticoagulated with warfarin (INR 2−3); start warfarin within 72hrs.|
|rivaroxaban||Xarelto||tabs||DVT, PE treatment||15mg twice daily for first 21 days, then 20mg once daily for the remaining treatment|
|Reduce risk of DVT, PE recurrence||20mg once daily|
|DVT prophylaxis – hip or knee replacement||10mg once daily 6−10hrs after surgery once hemostasis established. Hip: 35 days. Knee: 12 days.|
|inj||Postoperative DVT and PE low-dose prophylaxis – major abdominothoracic surgery or at risk of developing thromboembolic disease||See full labeling. >40yrs undergoing major surgery: 5000 IU SC (in the arm or abdomen) 2hrs before surgery and 5000 IU every 8−12hrs thereafter for 7 days or until the patient is fully ambulatory, whichever is longer.|
|Prophylaxis and treatment of PE||See full labeling. Individualize based on lab results and disease.|
|Low Molecular Weight Heparins|
|dalteparin||Fragmin||inj||DVT prophylaxis – abdominal surgery||2500 IU SC once daily 1−2hrs before surgery and repeated once daily
High risk: 5000 IU SC evening before surgery then once daily after surgery OR 2500 IU SC 1−2hrs before surgery followed by 2500 IU SC 12hrs later, then 5000 IU SC once daily. Usual duration of administration: 5−10 days.
|DVT prophylaxis – hip replacement||Post‑op start: 2500 IU SC 4−8hrs after surgery,
then 5000 IU SC once daily.
Pre‑op (day of surgery): 2500 IU SC 2hrs before surgery, followed by 2500 IU SC 4−8hrs after surgery, then 5000 IU SC once daily.
Pre‑op (evening before surgery): 5000 IU SC 10−14hrs before surgery, followed by 5000 IU SC 4−8hrs after surgery, then 5000 IU once daily. Usual duration of administration: 5−10 days after surgery
|DVT prophylaxis – medical patients||5000 IU SC once daily (usually for 12−14 days).|
|Extended treatment of symptomatic VTE (proximal DVT/PE), to reduce the recurrence of VTE in cancer patients||200 IU/kg SC once daily for 1mo, then 150 IU/kg SC once daily for 2−6mos; max 18,000 IU/day|
|enoxaparin||Lovenox||inj||DVT prophylaxis – abdominal surgery||40mg SC once daily 2hrs pre‑op for 7−10 days; max 12 days|
|DVT prophylaxis – hip replacement||30mg SC every 12hrs starting 12−24hrs post‑op, or 40mg SC once daily starting 9−15hrs pre‑op, for 7−10 days, then 40mg SC once daily for 3wks|
|DVT prophylaxis – knee replacement||30mg SC every 12hrs starting 12−24hrs post‑op for 7−10 days; max 14 days|
|DVT prophylaxis – medical patients||40mg SC once daily 6−11 days, max 14−days.|
|Acute DVT with or without PE (inpatient)
Acute DVT without PE (outpatient)
|Inpatient: 1mg/kg SC every 12hrs or 1.5mg/kg SC once daily
for up to 17 days with warfarin; start warfarin within 72hrs.
Outpatient: 1mg/kg SC every 12hrs for up to 17 days; with warfarin; start warfarin within 72hrs.
|Tissue Plasminogen Activators (tPA)|
|alteplase||Activase||inj||Treatment of acute massive PE for lysis||100mg IV infusion over 2hrs. May use heparin after infusion.|
Not an inclusive list of medications, official indications, and/or