Anticoagulation For Venous Thromboembolism

The primary focus of this website is for use of anticoagulants in patients with atrial fibrillation; however anticoagulation is also indicated for treatment in venous thromboembolism (VTE).

Dosing: VTE prophylaxis for total hip or knee replacement

IRVT_table_1
CrCl: creatinine clearance

Dabigatran:

110mg starting 4 hours after surgery then 220mg daily thereafter
75 mg starting 4 hours after surgery then 150mg daily thereafter in patients with moderate renal impairment.

Rivaroxaban: 10mg daily can be started 6 hours after surgery

Duration of prohylaxis:

Hip replacement: 5 weeks
Knee replacement: 2 weeks

Dosing: treatment of DVT/PE

CrCl >30ml/min: rivaroxaban 15mg which daily for three weeks followed by 20mg daily

For more information the following clinical trials can be referenced:

Rivaroxaban: First to be approved for use in acute treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE) and for the secondary prevention of VTE . The approval was based on the EINSTEIN DVT, EINSTEIN PE and EINTSTEIN Extension trials.

The EINSTEIN investigators. Oral rivaroxaban for symptomatic venous thromboembolism. NEJM 2010;363(26):2499-2510

The EINSTEIN-PE investigators. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. NEJM 2012: 366(14):1287-1297

Dabigatran: The RE-COVER trial randomized 2564 patients to 150mg twice daily of dabigatran or warfarin

Schulman et al. Dabigatran versus warfarin in the treatment of acute venous thromboembolism. NEJM 2009;361:2342-2352

Apixaban: AMPLIFY trial

Agnelli et al. Oral apixaban for the treatment of acute venous thromboemoblism. NEJM
2013;369:799-808

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Clinical Guide for Use of Oral Anticoagulants