DVT complete diagnostic approach resident survival guide

# Complete Diagnostic Approach
A complete diagnostic approach should be carried out after a focused initial rapid evaluation is conducted and following initiation of any urgent intervention.

## Initial Anticoagulation Choices (DVT)
 SC low molecular weight heparin (1st line)
 SC fondaparinux (1st line)
 IV unfractionated heparin
 SC unfractionated heparin

# Anticoagulation for VTE

## Warfarin
- Begin with 10 mg warfarin for 2 days followed by dosing based on the INR
- Start at the 1st or 2nd day of the initial parenteral therapy
- Target INR is 2-3
- Monitor INR:
If stable, repeat INR every 12 weeks
If stable but one value 0.5 below or above the target range, continue the same dose and repeat INR within 1-2 weeks
- If stable, repeat INR every 12 weeks
- If stable but one value 0.5 below or above the target range, continue the same dose and repeat INR within 1-2 weeks
- Avoid NSAIDs, COX2 selective NSAIDs and some antibiotics

# Heparin
IV-UFH
- 80 U/kg as bolus, followed by 18 U/kg/h
- 70 U/kg as bolus, followed by 15 U/kg/h for stroke or cardiac patients
SC-UFH
- 333 U/kg as bolus, followed by 250 U/kg
LMWH: decrease dose in renal insufficiency (Creatinine clearance < 30 mL/min)
Fondaparinux
- 7.5 mg daily
- 10 mg daily if weight>100 Kg
-  Bates SM, Jaeschke R, Stevens SM, Goodacre S, Wells PS, Stevenson MD;  et al. (2012). "Diagnosis of DVT: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines". Chest. 141 (2 Suppl): e351S418S. doi:10.1378/chest.11-2299. PMC 3278048. PMID 22315267.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link) CS1 maint: PMC format (link) .mw-parser-output cite.citation{font-style:inherit}.mw-parser-output q{quotes:"\"""\"""'""'"}.mw-parser-output code.cs1-code{color:inherit;background:inherit;border:inherit;padding:inherit}.mw-parser-output .cs1-lock-free a{background:url("")no-repeat;background-position:right .1em center}.mw-parser-output .cs1-lock-limited a,.mw-parser-output .cs1-lock-registration a{background:url("")no-repeat;background-position:right .1em center}.mw-parser-output .cs1-lock-subscription a{background:url("")no-repeat;background-position:right .1em center}.mw-parser-output .cs1-subscription,.mw-parser-output .cs1-registration{color:#555}.mw-parser-output .cs1-subscription span,.mw-parser-output .cs1-registration span{border-bottom:1px dotted;cursor:help}.mw-parser-output .cs1-hidden-error{display:none;font-size:100%}.mw-parser-output .cs1-visible-error{display:none;font-size:100%}.mw-parser-output .cs1-subscription,.mw-parser-output .cs1-registration,.mw-parser-output .cs1-format{font-size:95%}.mw-parser-output .cs1-kern-left,.mw-parser-output .cs1-kern-wl-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right,.mw-parser-output .cs1-kern-wl-right{padding-right:0.2em}
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