DEPARTMENT OF FAMILY MEDICINE

GUIDELINES FOR THE MANAGEMENT OF DEEP VEIN THROMBOSIS

1. Start with HEPARIN Na 5000U/IV and measure baseline PTT. 2. Then give 10,000U/s.c./8 hourly (first s.c. dose is at the same time as IV load). 3. Six hours after first s.c. dose check PTT and adjust as follows. __________________________________________ PTT Heparin dose___________ <1.5 x control to 12,000U s.c. 8hrly from next dose. 1.5-2.5 x control No change 2.6-4.0 x control 7500U s.c. 8hrly from next dose >4.0 x control 5000U s.c. 8hrly ___________________________________________ Give heparin for 5days from presentation aiming to keep PTT between 1.5-2.5 times control. PTT & INR should be done daily. Start warfarin 24 hrs after heparin. Continue heparin until the INR on warfarin is therapeutic(4-5 days) ___________________________________________ Day INR Warfarin dose in mg 1 2 <1.4 10 3 <2.0 10 >2.0 Nil 4 <2.0 10 2.0-2.9 5 3.0-3.4 2.5 >3.4 Nil 5 <1.5 7.5 1.5-2.5 5 >2.5 2.5 * The dose on day 5 is the predicted maintenance dose * The INR is valid if PTT is 1.5-2.5 x control * Patients on TB treatment, warfarin by a 3rd Warfarin for 6weeks for a reversible cause, severe illness 3months
January 2008