Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) Medications
|DEEP VEIN THROMBOSIS AND PULMONARY EMBOLISM (DVT/PE) MEDICATIONS*|
|Prophylaxis and treatment of DVT or PE||Individualize. IV: give as slow bolus dose over 1–2min into a peripheral vein. Initially 2–5mg orally or IV daily. Usual maintenance: 2–10mg daily. Variations in CYP2C9 or VKORC1 enzymes: use lower initial dose. Adjust dose and interval to maintain target INR 2.5 (2–3).|
|DIRECT THROMBIN INHIBITORS|
|Iprivask||desirudin||inj||DVT prophylaxis – hip replacement surgery||Administer 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|
|Arixtra||fondaparinux||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.|
|Xarelto||rivaroxaban||tabs||Treatment of DVT, PE
To reduce the risk of recurrence of DVT, PE following 6 months treatment
|15mg twice daily for first 21 days for the initial treatment, then 20mg once daily for the remaining treatment and the long-term reduction in the risk of recurrence of DVT and PE|
|DVT prophylaxis – hip or knee replacement||10mg once daily 6–10hrs after surgery once hemostasis established. Hip: 35 days. Knee: 12 days.|
|heparin sodium||inj||Postoperative DVT and PE low-dose prophylaxis – major abdominothoracic surgery or at risk of developing thromboembolic disease||See literature. >40yrs undergoing major surgery: 5000 Units SC (in the arm or abdomen) 2hrs before surgery and 5000 Units every 8–12hrs thereafter for 7 days or until the patient is fully ambulatory, whichever is longer.|
|Prophylaxis and treatment of PE||See literature. Individualize based on lab results and disease.|
|LOW MOLECULAR WEIGHT HEPARINS|
|Fragmin||dalteparin||inj||DVT prophylaxis – abdominal surgery||2500 Units SC once daily 1–2hrs before surgery and repeated once daily postoperatively.
High risk: 5000 Units SC evening before surgery then once daily after surgery OR 2500 Units SC 1–2hrs before surgery followed by 2500 Units SC 12hrs later, then 5000 Units SC once daily. Usual duration of administration: 5–10 days.
|DVT prophylaxis – hip replacement||Post-op start: 2500 Units SC 4–8hrs after surgery, then 5000 Units
SC once daily.
Pre-op (day of surgery): 2500 Units SC 2hrs before surgery, followed by 2500 Units SC 4–8hrs after surgery, then 5000 Units SC once daily.
Pre-op (evening before surgery): 5000 Units SC 10–14hrs before surgery, followed by 5000 Units SC 4–8hrs after surgery, then 5000 Units once daily. Usual duration of administration: 5–10 days after surgery
|DVT prophylaxis – medical patients||5000 Units 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 Units/kg SC once daily for 1 month, then 150 Units/kg SC once daily for 2–6 months; max 18,000 Units/day.|
|Lovenox||enoxaparin||inj||DVT prophylaxis – abdominal surgery||40mg SC once daily 2hrs prior to surgery for up to 12 days.|
|DVT prophylaxis – hip replacement||30mg SC every 12hrs or 40mg SC once daily starting 12hrs before surgery for up to 14 days.|
|DVT prophylaxis – knee replacement||30mg SC every 12hrs for up to 14 days.|
|DVT prophylaxis – medical patients||40mg SC once daily for up to 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)|
|Activase||alteplase||inj||Management of acute massive PE||100mg IV infusion over 2hrs. Concomitant use with heparin.|
DVT = deep vein thrombosis; inj = injection; PE = pulmonary embolism; SC = subcutaneous; tabs = tablets; VTE = venous thromboembolism
*Usual adult dosing based on manufacturers' PI. For more information see individual drug monographs.