If both contraindicated please contact Haematology via Raigmore switchboard (01463 704000). If Warfarin therapy to follow LMWH please could the GP complete the Warfarin Referral Form (requires internet access and access to NHS Highland Intranet) and send it to the Anticoagulant Clinic. Rivaroxaban contraindicated: start enoxaparin subcutaneous injectionsĮnoxaparin 1.5 mg/kg once daily (rounded to the nearest 10mg) for uncomplicated patients with low risk of venous thromboembolism (VTE) recurrence.Įnoxaparin 1 mg/kg twice daily should be used in all other patients such as those with obesity, symptomatic PE, cancer, recurrent venous thromboembolism (VTE) or proximal thrombosis.Īdjust dose in renal impairment (eGFR less than 30ml/min/1.73m 2), see SPCfor details. Recurrent DVT (or previous PE): 6 months and consider life-long anticoagulation (usually by switching from Rivaroxaban to Warfarin after 3 months. (3 months usually appropriate for temporary risk factors and low risk of recurrence, 6 months for idiopathic DVT or permanent risk factors) If active malignancy treat with low molecular weight heparin.Īll patients should be individually assessed for risk: benefit, but the following should be considered:įirst DVT confined to below knee clot (or superficial femoral): 6 weeks to 3 monthsįirst DVT, affecting ileo-femoral veins (except superficial femoral): 3 to 6 months. Mild (CrCl 50 to 80mL/min) renal impairment: no dosage adjustment necessary. ![]() Moderate (CrCl 30 to 49mL/min) or severe (CrCl 15 to 29mL/min) renal impairment: consider reducing maintenance dose from 20 mg once daily to 15 mg once daily if the patient's assessed risk for bleeding outweighs the risk for recurrent DVT and PE. Rivaroxaban is contraindicated if creatinine clearance is less than 15ml/min. Initial therapeutic dose (oral): rivaroxaban 15mg twice daily for 21 days then maintentance dose: 20mg once daily thereafter. The doctors will review you and decide if you will benefit from anticoagulant medication to thin the blood and reduce clotting.Patients who are considered on clinical grounds as being at moderate or high risk of DVT (Wells’ score -2) and who are not getting ultrasound and follow up the same day should be treated with rivaroxaban pending confirmation of diagnosis. What if my test shows I have a blood clot? The results of your scan will be sent back to your doctor, or if you have been referred from A&E we will give you your report to take back to the doctors there immediately after. The flow in your veins will be examined, which usually requires some gentle squeezing of the calf, and the veins will be compressed to make sure they are not obstructed by clot, which involves some gentle pressure with the ultrasound probe. On visiting the vascular lab for a DVT assessment, we will use an ultrasound scanner with some cool gel to visualise the veins in the affected limb or limbs. ![]() Why does DVT occur?ĭVT can occur if the limb or vein affected has been involved in trauma or injury, if the limb has been immobile for a prolonged period of time (for example during bed rest or long haul flight), or if the mechanisms for normal blood clotting are for some reason altered (eg. DVT is the partial or total blockage of one or several veins in a limb by clotting of the blood, which can lead to symptoms described above. If you have symptoms such as swelling, tenderness and pain of one or both legs (or less commonly arms), your doctor may send you to the vascular lab for an ultrasound to test for DVT (Deep Vein Thrombosis).
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