Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) Medications

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THROMBOEMBOLIC DISORDER TREATMENTS: DVT/PE
THROMBOEMBOLIC DISORDER TREATMENTS: DVT/PE
Generic Brand Form Indication Adult Dose
ANTICOAGULANTS
Coumarins
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 dose.
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
fondapar-
inux
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.
Heparins
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 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 literature. 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 postoperatively.
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.
THROMBOLYTICS
Tissue Plasminogen Activators (tPA)
alteplase Activase inj Management of acute massive PE 100mg IV infusion over 2hrs. May use heparin after infusion.
NOTES

Key:
DVT = deep vein thrombosis;
PE = pulmonary embolism;
VTE = venous thromboembolism

Not an inclusive list of medications, official indications, and/or dosing details.
Please see drug monograph at www.eMPR.com and/or contact company for full drug labeling.

(Rev. 2/2016)

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