DVT/PE and active cancer: Extended treatment, with periodic risk-benefit analysis (ACCP recommends LMWH over vitamin K antagonist therapy).
Second unprovoked DVT or PE with high bleeding risk: Treatment duration of 3 months.
Second unprovoked DVT or PE with low or moderate bleeding risk: Extended treatment.
First unprovoked distal DVT regardless of bleeding risk: Treatment duration of 3 months.
First unprovoked proximal DVT or PE with high bleeding risk: Treatment duration of 3 months.
First unprovoked proximal DVT or PE with low or moderate bleeding risk: Extended treatment consideration with periodic (ie, annual) risk-benefit analysis.
Transient (reversible) risk factor-induced DVT or PE: Treatment duration of 3 months.
Surgery-provoked DVT or PE: Treatment duration of 3 months.
Overlap warfarin and parenteral anticoagulant for at least 5 days until desired INR (>2.0) maintained for 24 hours, then discontinue parenteral therapy.
Initiate warfarin on day 1 or 2 of parenteral anticoagulation therapy (eg, LMWH or unfractionated heparin).
Typical maintenance dose ranges between 2 and 10 mg/dayĬonsider dosage based on genotype (see Genomic Considerations) DVT and PE treatment Initiate warfarin on day 1 or 2 of LMWH or unfractionated heparin therapy and overlap until desired INR, THEN discontinue heparinĬheck INR after 2 days and adjust dose according to results Initial dose: 2-5 mg PO/IV qDay for 2 days, OR 10 mg PO for 2 days in healthy individuals Prophylaxis and treatment of venous thrombosis and its extension, pulmonary embolism (PE)