During this time warfarin is generally begun, and it is important to continue the patient on warfarin for five to seven days while the patient is receiving intravenous heparin therapy. After stopping heparin, oral anticoagulation with warfarin should be continued for six weeks.
There are additional costs and possible adverse events associated with using a non-heparin anticoagulant, plasma exchange and heparin, or heparin and an antiplatelet agent. Overall, the desirable consequences of using heparin and the undesirable consequences of using the other treatment strategies probably favor use of heparin.
However, once venous thrombosis has already occurred, it is necessary to use full-dose heparin, preferably by the continuous intravenous route, with maintenance of the partial thromboplastin time (PTT) at 1 1/2 times the control at all times. Although monitoring the PTT may not prevent hemorrhage, it will help prevent further thrombosis.
An alternative approach is to commence heparin and oral anticoagulants together at the time of diagnosis, and to discontinue heparin on the fourth or fifth day.
Duration of treatment — Anticoagulation is recommended for a MINIMUM of three months in a patient with DVT.
For patients who have a new clot, heparin is usually given with another anticoagulant, warfarin (Coumadin®). Warfarin is a pill that patients can take at home for long term anticoagulation. Because it can take 5-7 days (or longer) for the warfarin to take effect, patients will initially take both drugs.
Heparin works faster than warfarin, so it is usually given in situations where an immediate effect is desired. For example, this medication is often given in hospitals to prevent growth of a previously detected blood clot.
Duration of Anticoagulation For the first episode of deep venous thrombosis (DVT), patients should be treated for 3-6 months. Recurrent episodes should be treated for at least 1 year.
Heparin is usually given short-term, and warfarin is added in combination with heparin, before heparin is stopped. It can take 5-7 days (or longer) for the warfarin to reach an adequate level for it to be given alone.
Heparin must be overlapped with oral warfarin because of the initial transient hypercoagulable state induced by warfarin. This effect is related to the differential half-lives of protein C, protein S, and the vitamin K–dependent clotting factors II, VII, IX, and X.
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Warfarin should be stopped 5 days before surgery. The main decision is whether to give bridging anticoagulant therapy with full treatment doses of low molecular weight heparin (LMWH) or, less commonly with unfractionated heparin (UFH) once the INR is less than 2.0.
Heparin is taken as a shot, and it works more quickly than Warfarin. You get the type called unfractionated heparin (UFH) through an IV, usually in a hospital. The more you weigh, the more your doctor will give you. The hospital staff will check your blood regularly to make sure your dosage is correct.
The optimal duration of intravenous heparin treatment is five to seven days because this is the time needed to obtain an adequate and persistent reduction in the vitamin K dependent clotting factors with oral anticoagulants such as warfarin.
It usually takes about 3 months to treat a DVT. If you aren't likely to have another one, you may be able to stop taking blood thinners at that point. People whose chances are higher may need to stay on them for years.
Hide table of contents2 hours pre-operatively:5,000 units subcutaneouslyfollowed by:5,000 units subcutaneously every 8-12 hours, for 7-10 days or until the patient is fully ambulant.