Treating a patient who has had a DVT or PE

NB: This page is an overview; the other guidelines on this website will provide more detailed information on individual drugs and circumstance and you should also refer to those.

· Establish diagnosis: compression ultrasound for DVT or CTPA for PE.  In proven PEs it may be worth getting a compression ultrasound to establish whether a DVT is also present (perhaps as the source of the PE)

· Contact the anti-coagulation nurse specialist, Debi Smith x8407 / 93 8545

· Check for contraindications and precautions, then start low molecular weight heparin, usually enoxaparin (Clexane) 1mg/Kg bd, subcut.  See separate section on starting enoxaparin.

· At the same time, start warfarin according to the nomogram (also on this website).  For duration of warfarin therapy, see ‘using warfarin’ elsewhere on this website.

· Continue enoxaparin until a last dose 24 hours after the INR has reached 2.0.  If this takes less than 5 days, continue for 5 days anyway.   (this is because until that time, the warfarin is not providing proper anticoagulation)