TREATMENT PLAN
TREATMENT PLAN
Warfarin dosing:
- Check PT/INR before starting
- Initial: 10mg first 2 days
- 5mg for elderly/low body weight
- Maintenance: 3-9mg daily
- Same time each day
- Combine with LMWH if immediate effect is needed (e.g., DVT/PE) – Surgical management:
- Stop 3-5 days pre-surgery
- If cannot stop: aim INR <2.5 with LMWH – Minor surgery: no need to stop
Apixaban:
- Surgical management:
- Stop 3 days before high-risk procedures
- stop 1 day before low-risk procedures
Treatment duration:
- Distal DVT: 6 weeks
- Proximal DVT with risk factors: 3 months
- Proximal DVT without risk factors: 6 months
- Recurrent DVT/PE: long-term
- AF: long-term
- If undergoing Cardioversion requires INR correction 3 weeks before and 4
days after
- Prosthetic heart valves: long-term
KEY INFORMATION
- Warfarin to DOAC switch: ensure INR <2
- DOAC to warfarin switch: overlap for 2 days until therapeutic INR, once in range, the DOAC can be stopped.