Therapeutic Anticoagulation: Treats known blood clots
Prophylactic Anticoagulation Regimens
Common Options
Lovenox (enoxaparin) 40 mg daily
Reduced dose: 30 mg for patients with AKI (Acute Kidney Injury)
Heparin 5000 units
Administered every 8 or 12 hours
7500 units for obese patients
Obese Patients: Lovenox 0.5 mg/kg daily
Choosing the Right Regimen
Lovenox 40 mg: Preferred for most patients
Heparin or Lovenox 30 mg: For patients with AKI
Sequential Compression Devices (SCDs): Used for mechanical prophylaxis, especially if the patient is at high bleeding risk and can't receive pharmacologic prophylaxis. Also known as IPC (Intermittent Pneumatic Compression).
Determining the Need for DVT Prophylaxis
Most Patients: Especially older and less mobile, require DVT prophylaxis
Padua Score: Can be used to assess DVT risk
Therapeutic Anticoagulation Regimens
Common Options
Apixaban (Eliquis): 5 mg BID; reduced to 2.5 mg BID for patients >80 years old, weight <60 kg, or creatinine >1.5
Loading dose: 10 mg BID for 7 days (for DVT/PE)
Rivaroxaban (Xarelto): 20 mg daily; loading dose of 15 mg BID for 21 days (for DVT/PE)
Must be taken with food
Dabigatran: 150 mg BID; requires 5 days of IV anticoagulation before starting
Heparin Drip: Fast on and off; useful for patients requiring quick adjustments (e.g., before procedures)
Warfarin (Coumadin): Vitamin K antagonist; requires frequent INR monitoring (goal: 2-3). Critical to manage diet and drug interactions.
Lovenox (enoxaparin): 1 mg/kg BID or 1.5 mg/kg daily
Choosing Between Anticoagulants
Apixaban vs. Rivaroxaban:
Apixaban: Preferred for stable anticoagulation levels and reduced risks of thrombosis and bleeding
Rivaroxaban: Simpler once-daily dosing; better for patients with adherence issues, despite higher risks of thrombosis and bleeding