Acute Anticoagulation                                                             RCH Anticoagulation Policy

 

Acute anticoagulation needs to be started at treatment dose when clinical suspicion of thromboembolic disease is high, even if pending investigation. D-dimer assays remain a useful tool up to 24 hours after full anticoagulation, so if the patient is referred immediately anticoagulation should not effect diagnostic sensitivity.

 

Traditionally, rapid therapeutic-dose anticoagulation in the acute patient has been with achieved with subcutaneous low molecular weight heparin (LMWH). Locally, we now use enoxaparin as first line LMWH, with altered dosing in those with renal impairment (creatinine clearance <30ml/min).

 

Such rapid anticoagulation can also be achieved with oral Rivaroxaban therapy as an alternative to LMWH. (Please note that whilst none of the DOACS or LMWH are licensed for use in suspected VTE awaiting imaging, the licence for treatment of VTE in dabigatran does require a 5-day lead-in with LMWH prior to initiating and so is likely a less appropriate choice to rivaroxaban - Andrew McSorley, Thrombosis team)

 

Please click each option for the BNF online prescribing information

 

Dalteparin

 

Enoxaparin

 

Rivaroxaban

 

Apixaban

 

Others

 

The AGP's local guidelines for the treatment of PE are available here.