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, dalteparin (Fragmin) has been used as first line LMWH, with the use of enoxaparin (Clexane) in those with renal impairment (creatinine clearance <30ml/min).
Recently, such rapid anticoagulation can 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