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Deep vein thrombosis

Updated : September 2, 2022





Background

Epidemiology

Anatomy

Pathophysiology

Etiology

Genetics

Prognostic Factors

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

 

edoxaban 

After 5-10 days of initial treatment:

≤60kg:30mg orally every day >60kg:60mg orally every day



Dose Adjustments

Renal impairment (PE/DVT)
15-50ml/min-30mg orally every day
>50ml/min-No dosage adjustment needed
Renal impairment (Atrial fibrillation)
CrCl<15ml/min: No data available
CrCl 15-50ml/min:30mg orally every
day
CrCl>50-95ml/min: Dosage adjustment not necessary
CrCl>95ml/min: Not recommended

dalteparin 


indicated for Deep vein thrombosis after Hip replacement surgery:


Beginning of the preoperative period (the evening before surgery; allow approximately 24 hours between doses)
5000 IU subcutaneously every 10-14 hours before surgery
5000 IU subcutaneous every 4-8 hours after surgery
5000 IU subcutaneous during the postoperative period administer once a day

• Day of surgery-preoperative start
Subcutaneous administration of 2500 international units within two hours of surgery
2500 international units subcutaneously 4 to 8 hours after surgery or later if hemostasis has not been achieved
Allow a minimum of 6 hours between this dose and the dose to be given on postoperative day 1, and adjust the timing of the dose on postoperative day one accordingly. Five thousand international units subcutaneously once a day during the postoperative period

• Postoperative period
2500 international units subcutaneously 4 to 8 hours after surgery or later if hemostasis has not been established; allow a minimum of 6 hours between this dosage and the dose to be administered on postoperative day 1 and alter the scheduling of the dose on postoperative day 1 appropriately 5000 international units subcutaneously once daily during the postoperative period
Therapy duration:5 to 10days after surgery



dalteparin 


Deep vein thrombosis after abdominal surgery:


• Moderate thromboembolic risk:
2500 international units subcutaneously once a day, beginning 1 to 2 hours before surgery and continued once a day postoperatively.

• High thromboembolic risk:
may be administered as a subcutaneous injection the evening before surgery and once a day postoperatively at a dose of 5000 IU per injection or as two injections of 2500 IU, each given 1 to 2 hours apart before surgery, followed by a daily injection of 5000 IU postoperatively

Therapy duration:5-10days



heparin 

Prophylaxis
7500 units subcutaneous every 12 hours, OR
5000 units subcutaneous every 8-12hours
Treatment
Intravenous bolus of 80 units/kg, following continuous infusion of about 18 units/kg in hour, OR
subcutaneous injection 250 units/kg, following 250 units/kg for every 12 hours
5000 units Intravenous bolus, following continuous infusion of 1300 units/hr, OR
Dosing considerations
There are a number of concentrations available; caution is necessary to prevent the medication errors



dabigatran 


Indicated for Deep Vein Thrombosis – Prophylaxis
150 mg orally two times a day
Note: If required, anticoagulant activity can be evaluated using aPTT or ECT instead of INR, although typically the measurement of anticoagulant activity is unnecessary with this medication
Prevention of Thromboembolism in Atrial Fibrillation
150 mg orally two times a day
Note: If required, anticoagulant activity can be evaluated using aPTT or ECT instead of INR, although typically the measurement of anticoagulant activity is unnecessary with this medication
Deep Vein Thrombosis or Pulmonary Embolism as Prophylaxis Following Hip Replacement Surgery
The recommended dosing regimen for this medication is to administer 110 mg orally 1-4 hours following surgery and after hemostasis has been achieved. Subsequently, the patient should take 220 mg orally one time a day for a duration of 28-35 days
Note: In the event that this medication is not administered on the day of surgery, treatment should begin with 220 mg orally one time a day after hemostasis has been established



desirudin 

Indicated for prophylactic treatment of deep vein thrombosis in patients who will undergo elective hip replacement surgery
Initially, 15 mg subcutaneously 5-15 minutes before surgery (only after regional anesthesia)
Maintain the dose at 15 mg subcutaneously every 12 hours
Carry out the evaluation risk of the bleeding disorder before drug administration
The product is discontinued in the United States



nadroparin 

For Patients with standard bleeding risk:
Administer dose of 171 anti-Xa units/kg subcutaneously one time a day
Fixed dosing:
40 to 49 kg: dose of 7600 anti-Xa units subcutaneously one time daily
≥90 kg: dose of 17100 anti-Xa units subcutaneously one time daily
For Patients with increased risk for bleeding:
Administer dose of 86 anti-Xa units/kg subcutaneously each 12 hours
Fixed dosing:
40 to 49 kg: dose of 3800 anti-Xa units subcutaneously each 12 hours
≥90 kg: dose of 8550 anti-Xa units subcutaneously each 12 hours



anisindione 

Take initial dose of 300 mg, 200 mg and 100 mg orally on first, second and third day respectively



certoparin 


Indicated for Deep Vein Thrombosis
One time a day subcutaneously
The maximum dose is 3000 IU



 
 

dalteparin 


Indicated for Deep vein thrombosis after abdominal surgery:


• Moderate thromboembolic risk:
2500 international units subcutaneously once a day, beginning 1 to 2 hours before surgery
• High thromboembolic risk:
may be administered as a subcutaneous injection the evening before surgery and once a day postoperatively at a dose of 5000 IU per injection



dalteparin 


Indicated for Deep vein thrombosis after Hip replacement surgery:


• Day of surgery-preoperative start
Subcutaneous administration of 2500 international units within two hours of surgery
• Postoperative period
2500 international units subcutaneously 4 to 8 hours after surgery thereafter 5000IU every day



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References

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Deep vein thrombosis

Updated : September 2, 2022




edoxaban 

After 5-10 days of initial treatment:

≤60kg:30mg orally every day >60kg:60mg orally every day



Dose Adjustments

Renal impairment (PE/DVT)
15-50ml/min-30mg orally every day
>50ml/min-No dosage adjustment needed
Renal impairment (Atrial fibrillation)
CrCl<15ml/min: No data available
CrCl 15-50ml/min:30mg orally every
day
CrCl>50-95ml/min: Dosage adjustment not necessary
CrCl>95ml/min: Not recommended

dalteparin 


indicated for Deep vein thrombosis after Hip replacement surgery:


Beginning of the preoperative period (the evening before surgery; allow approximately 24 hours between doses)
5000 IU subcutaneously every 10-14 hours before surgery
5000 IU subcutaneous every 4-8 hours after surgery
5000 IU subcutaneous during the postoperative period administer once a day

• Day of surgery-preoperative start
Subcutaneous administration of 2500 international units within two hours of surgery
2500 international units subcutaneously 4 to 8 hours after surgery or later if hemostasis has not been achieved
Allow a minimum of 6 hours between this dose and the dose to be given on postoperative day 1, and adjust the timing of the dose on postoperative day one accordingly. Five thousand international units subcutaneously once a day during the postoperative period

• Postoperative period
2500 international units subcutaneously 4 to 8 hours after surgery or later if hemostasis has not been established; allow a minimum of 6 hours between this dosage and the dose to be administered on postoperative day 1 and alter the scheduling of the dose on postoperative day 1 appropriately 5000 international units subcutaneously once daily during the postoperative period
Therapy duration:5 to 10days after surgery



dalteparin 


Deep vein thrombosis after abdominal surgery:


• Moderate thromboembolic risk:
2500 international units subcutaneously once a day, beginning 1 to 2 hours before surgery and continued once a day postoperatively.

• High thromboembolic risk:
may be administered as a subcutaneous injection the evening before surgery and once a day postoperatively at a dose of 5000 IU per injection or as two injections of 2500 IU, each given 1 to 2 hours apart before surgery, followed by a daily injection of 5000 IU postoperatively

Therapy duration:5-10days



heparin 

Prophylaxis
7500 units subcutaneous every 12 hours, OR
5000 units subcutaneous every 8-12hours
Treatment
Intravenous bolus of 80 units/kg, following continuous infusion of about 18 units/kg in hour, OR
subcutaneous injection 250 units/kg, following 250 units/kg for every 12 hours
5000 units Intravenous bolus, following continuous infusion of 1300 units/hr, OR
Dosing considerations
There are a number of concentrations available; caution is necessary to prevent the medication errors



dabigatran 


Indicated for Deep Vein Thrombosis – Prophylaxis
150 mg orally two times a day
Note: If required, anticoagulant activity can be evaluated using aPTT or ECT instead of INR, although typically the measurement of anticoagulant activity is unnecessary with this medication
Prevention of Thromboembolism in Atrial Fibrillation
150 mg orally two times a day
Note: If required, anticoagulant activity can be evaluated using aPTT or ECT instead of INR, although typically the measurement of anticoagulant activity is unnecessary with this medication
Deep Vein Thrombosis or Pulmonary Embolism as Prophylaxis Following Hip Replacement Surgery
The recommended dosing regimen for this medication is to administer 110 mg orally 1-4 hours following surgery and after hemostasis has been achieved. Subsequently, the patient should take 220 mg orally one time a day for a duration of 28-35 days
Note: In the event that this medication is not administered on the day of surgery, treatment should begin with 220 mg orally one time a day after hemostasis has been established



desirudin 

Indicated for prophylactic treatment of deep vein thrombosis in patients who will undergo elective hip replacement surgery
Initially, 15 mg subcutaneously 5-15 minutes before surgery (only after regional anesthesia)
Maintain the dose at 15 mg subcutaneously every 12 hours
Carry out the evaluation risk of the bleeding disorder before drug administration
The product is discontinued in the United States



nadroparin 

For Patients with standard bleeding risk:
Administer dose of 171 anti-Xa units/kg subcutaneously one time a day
Fixed dosing:
40 to 49 kg: dose of 7600 anti-Xa units subcutaneously one time daily
≥90 kg: dose of 17100 anti-Xa units subcutaneously one time daily
For Patients with increased risk for bleeding:
Administer dose of 86 anti-Xa units/kg subcutaneously each 12 hours
Fixed dosing:
40 to 49 kg: dose of 3800 anti-Xa units subcutaneously each 12 hours
≥90 kg: dose of 8550 anti-Xa units subcutaneously each 12 hours



anisindione 

Take initial dose of 300 mg, 200 mg and 100 mg orally on first, second and third day respectively



certoparin 


Indicated for Deep Vein Thrombosis
One time a day subcutaneously
The maximum dose is 3000 IU



dalteparin 


Indicated for Deep vein thrombosis after abdominal surgery:


• Moderate thromboembolic risk:
2500 international units subcutaneously once a day, beginning 1 to 2 hours before surgery
• High thromboembolic risk:
may be administered as a subcutaneous injection the evening before surgery and once a day postoperatively at a dose of 5000 IU per injection



dalteparin 


Indicated for Deep vein thrombosis after Hip replacement surgery:


• Day of surgery-preoperative start
Subcutaneous administration of 2500 international units within two hours of surgery
• Postoperative period
2500 international units subcutaneously 4 to 8 hours after surgery thereafter 5000IU every day



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