Editing Thrombosis (section)

== '''Anticoagulants in thrombosis''' ==

* DOAC - 3/12 is shortest acceptable treatment for provoked DVT
** Apixaban 10mg BD for one week then 5mg BD
** Rivaroxaban 15mg BD for 3 weeks then 20mg daily
* Warfarin preferred if: (starting dose 5mg daily in most patients)
** Weight 120kg or BMI >40
** Weight less than 40kg
** APLS
** Mechanical heart valve
** Any contraindication to DOAC, including eGFR <30
* Warfarin starting dose 5mg daily in most patients. Need to bridge while loading for patients with VTE, until INR >2 for 2 consecutive days
* Enoxaparin - primarily for cancer-related thrombosis, pregnancy and superficial vein thrombosis. 1mg/kg BD or 1.5mg/kg daily.
** Check enoxaparin anti-Xa levels in patients with renal failure, extremes of weight, suspected non-compliance or overdose. Therapeutic level (peak, 4 hours post dose) is 0.5-1.0 units/mL if on a twice daily regimen.
* Unfractionated heparin
** Primarily used when rapid onset and offset is desired
** Plasma heparin anti-Xa level can be used to guide dosing in some patients:
*** Failure to achieve an APTT result within the therapeutic range after 24 hours
*** Heparin resistance (i.e., requirement of >35,000 units of UFH per 24 hours to achieve an APTT result within therapeutic range)
*** Lupus anticoagulant (prolongs baseline APTT)
*** >100kg
*** Pregnant
*** Need to achieve therapeutic range rapidly
*** Markedly raised acute phase reactants