DVT prophylaxis doses:
– Use lovenox 40mg subcutaneous Qday if Cr clearance > 30
– Use lovenox 30mg subcutaneous Qday if Cr clearance <30
– Use heparin 5000mg BID/TID if severe renal impairment with Cr clearance <15 (dialysis patients). One can also use this instead of lovenox 30mg Qday, however heparin is thrice a day administration and means more frequent sticks for the patient.
-SCD’s in patients in whom pharmacological prophylaxis is contraindicated, or patients who are admitted under ‘observation’ status and will be discharged the next day.
TIP: for a patient in whom DVT is highly suspected, avoid SCDs until a Doppler ultrasound has been performed to rule out a DVT.
Not necessary if the patient is on Warfarin with an INR that is therapeutic.
- Lovenox (enoxaparin) (most people):
- Prophylactic: 40mg SubQ qd
- Therapeutic: 1mg/kg/dose SubQ q12hrs (+D-dimer, + Doppler US): Use if PE, MI, DVT!
- Heparin (kidney failure or procedure/surgery the next day (AM): LHC, orthopedic surgery)
- Heparin 5,000 U (1ml) SubQ q12hr [kidney failure]
- Heparin 4,000U/dose IV drip (low dose: 45U/kg/dose)
- SCD (sequential compression device): Use if patient is able to get up and walk around, less of a risk for DVT, or actively bleeding.