What is the perioperative medication management to treat deep vein thrombosis (DVT)?

Updated: Jan 09, 2018
  • Author: Nafisa K Kuwajerwala, MD; Chief Editor: William A Schwer, MD  more...
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Answer

Answer

When the diagnosis of DVT is made postoperatively, begin full-dose heparinization (bolus of 5000-10,000 IU, followed by continuous infusion of 1000-1500 IU/h) if surgical hemostasis is achieved. If a risk is still present, an inferior vena cava filter must be placed. Once on therapeutic heparin (aPTT of 1.5-2), warfarin should be initiated and the dose adjusted to maintain an appropriate INR (ie, 2-3). Heparin and a therapeutic level of warfarin should overlap for at least 48 hours before discontinuing heparin.

If edema is present, the patient should remain on bed rest with the affected limb elevated above the level of the heart for several days. The patient should remain on bed rest for 2-3 days even if no pain or edema is present and even if the aPTT is at a therapeutic range to allow fixation of the clot to the vessel wall. Administer 3-6 months of therapy in the case of proximal DVT, assuming that surgery was the only predisposing risk factor. LMWH may also be used in conjunction with warfarin for therapy of DVT.

  • Dalteparin sodium (approved in Canada) is administered at 200 anti-Xa IU/kg/d subcutaneously, with a single dose not to exceed 18,000 IU.

  • Enoxaparin sodium (approved in Canada and the United States) is administered at 1 mg/kg q12h subcutaneously or at 1.5 mg/kg/d subcutaneously. The single daily dose should not exceed 150 mg.

  • Nadroparin calcium (approved in Canada) is administered at 86 anti-Xa IU/kg bid subcutaneously for 10 days or at 171 anti-Xa IU/kg subcutaneously daily. The single daily dose should not exceed 17,000 IU.

  • Tinzaparin sodium (approved in Canada and the United States) is administered at 175 anti-Xa IU/kg/d subcutaneously daily.


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