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Anti-coagulation in PE (LMWH (Active Malignancy
-Pregnancy, in…
Anti-coagulation in PE
Which Patients?
patients with symptomatic pulmonary embolism (PE) and most patients with subsegmental PE should be anticoagulated
Initial Anticoagulation
anticoagulation administered immediately following the diagnosis of PE >> typically first 0 to 10 days
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Baseline coagulation tests (prothrombin time, international normalized ratio [INR], activated partial thromboplastin time [aPTT]) should be drawn prior to the initiation of anticoagulation to guide therapy
LMWH
- Active Malignancy
-Pregnancy
in whom warfarin, dabigatran, or edoxaban is chosen as the agent for long-term use
anticoagulation cannot be assured via the oral route (eg, malabsorption, vomiting)
(enoxaparin, dalteparin, tinzaparin)
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Greater bioavailability
●Duration of the effect longer
●Fixed dosing is feasible
●Laboratory monitoring is not necessary
●Lower risk of HIT
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Long term Maintainence
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Warfarin
severe renal insufficiency, Cost issues
long-term anticoagulation, it is generally started on the same day with LMW heparin or UFH (day 1) at a typical initiating dose of 5 mg/day for the first two days [18,19]. Dosing is then adjusted until the INR is within the therapeutic range (2 to 3; target 2.5) for two consecutive days
Interruptions should be minimized during the first three months of anticoagulation because this is the period that has the highest risk of recurrent thrombosis
EINSTEIN-PE Rivaroxaban 15 mg by mouth twice daily for three weeks followed by 20 mg once daily
AMPLIFY Apixaban 10 mg twice daily for seven days followed by 5 mg twice daily
●Edoxaban 60 mg once daily
RECOVER, RECOVER-1, RECOVER-2 Dabigatran 150 mg twice daily
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