*Heparin 5,000 IU SC BD until the condition is fully treated.
*Enoxaparin sodium at the following dose: Moderate risk: 20mg, 1-2hours before surgery then 20mg OD for 7-10 days. High risk: 40mg 12hours before surgery then 40mg OD for 7-10 days.
*Elastic compression stockings
*Stretching and flexing of the feet and pressing of the toes (useful during the long-hours flight).
*Placing the body onTrendelenburg position (the body is laid flat on the supine position with the feet higher than the head by 15-30 degrees)
**Unfractionated heparin: 80 IU/kg IV bolus followed by 18 IU/kg/hr infusion for 2-5 days. Monitor PTT and adjust the dose to maintain the PTT value that is 1.5 to 2.0 times of the control.
**Enoxaparin sodium 1mg/kg SC BD
**Dalteparin 200 IU / day SC.
**Warfarin being started from the first day; 10 mg OD x 2/7 then check INR and adjust the dose accordingly until the INR values are 2-3 times of the control for 2 consecutive days. Discontinue heparin and continue warfarin treatment for 6weeks for calf vein thrombosis and 3-6 months for proximal vein thrombosis.
**Unfractionated heparin 6,000 IU STAT
then target 24,000 - 30,000 IU per day by infusion. Monitor PTT and adjust the dose to maintain the PTT value that is 2 times of the control.
** Inferior vena cava filter (IVC filter)
** Thrombolytics that include; Reteplase at the following dose: 10U bolus dose followed by a second 10U bolus dose 30 minutes later [double bolus]. Each bolus is administered as a slow intravenous injection within 2 minutes. Heparin and acetylsalicylic acid should be administered before and following its administration to reduce the risk of rethrombosis.
* Dabigatran that is taken at the following dose: Prophylaxis of VTE following total knee replacement surgery,adult over 18 years, 110 mg [elderly over 75 years, 75 mg] 1- 4 hours after surgery, then 220 mg [elderly over 75 years, 150 mg] once daily for 9 days. Prophylaxis of venous thromboembolism following total hip replacement surgery, adult over 18 years, 110 mg [elderly over 75 years, 75 mg] 1-4 hours after surgery, then 220 mg [elderly over 75 years, 150 mg] once daily for 27–34 days. Note: Max. 150mg daily with concomitant amiodarone or verapamil.