Uganda guidelines for the treatment of Thrombosis/Pulmonary Embolism (DVT/PE)
Uganda Clinical Guidelines 2023 · all from source →
General Adult
Diagnosis
Clinical Features
50% of cases clinically silent. Pain, swelling, warmth of calf, thigh, and groin. PE characterised by dyspnoea, tachycardia, chest pain, hypotension.
Investigations
Compression ultrasound +/- doppler. In case of PE: chest CT angiogram. Blood D-dimer, ECG, Chest X ray, echo cardiogram.
Treatment
Initial Management (Heparin + Warfarin)
Enoxaparin (LMWH) 1 mg/kg every 12 hours (or 1.5mg/kg once a day) for at least 5 days. PLUS warfarin 5 mg single dose given in the evening, commencing on the same day as the heparin. Stop heparin when warfarin dose leads to an optimal INR of 2-3.
Alternative to LMWH
Unfractionated heparin: 5000 units IV bolus then 1000 units hourly OR 17500 units SC 12 hourly for 5 days. Adjust dose according to APTT. OR 333 units/kg SC as an initial dose followed by 250 units/kg SC every 12 hours. PLUS warfarin as above.
Alternative to Warfarin/Heparin (DOACs)
Rivaroxaban: 15mg orally twice a day for 3 weeks then 20mg daily (no heparin needed). OR Apixaban: 10mg twice a day for 7 days then 5mg twice a day. Do not use DOACs in pregnancy/breastfeeding.
Prevention
Early mobilisation. Prophylaxis with enoxaparin 40 mg SC daily in any acutely ill medical patient and in prolonged admission.
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