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Medical Oncology • Internal Medicine • Thrombosis • Hematology • Hemostasis/Thrombosis • Pulmonology • Pulmonary Vascular Disease • Pulmonary Embolus
For patients with newly diagnosed VTE on IV heparin planned for transition to DOAC, would you start at the loading or maintenance DOAC dose?
If they have been on IV heparin for 3 days, for example, would you subtract those days from the recommended loading dose time?
Answer from: at Community Practice
Agree with Dr. @Tapson. In the clinical trials that led to rivaroxaban and apixaban approval, many patients had 2 days of injected anticoagulant first to arrive at successful outcomes leading to DOAC approval. I suggest IV heparin until hemodynamically normal (for PE), sq LMWH for a dose or two for ...
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Answer from: at Academic Institution
No solid data. Still, I always go to full dose DOAC regimen unless the bleeding risk is high.
Answer from: at Community Practice
Enoxaparin upfront unless there is a bad renal failure, and then start a regular loading schedule for the DOAC.
Unlikely, they’ve been therapeutic the full time they were on heparin, so I would not count/trust those days anyway.