Anticoagulant Treatment

Oral anticoagulants
  • Warfarin is the most commonly used oral anticoagulant in the world.
Treatment for Atrial Fibrillation
  • Patients with newly diagnosed atrial fibrillation can be started on warfarin directly.
  • They do not need an initial course of LMW heparin unless they have had a recent stroke.
  • Treatment should be started with a loading dose of 3mg or 5mg daily for the first 3 days of treatment.
  • More information about warfarin.
Treatment for Deep Vein Thrombosis (DVT) or Pulmonary Embolus (PE)
  • Treatment with warfarin requires a short course of LMW heparin initially.
  • LMW heparin is given as soon as the diagnosis is suspected.
  • In a confirmed case, LMW heparin is given for at least 5 days and continued until the INR is therapeutic.
  • Warfarin is started at the time of diagnosis.
  • A loading dose (typically 5mg daily) is given for 3 days and an INR check is performed on day 4.
  • The dose is adjusted depending on the INR result.
  • Warfarin is continued for 6 weeks to 6 months depending on the clinical condition.
  • Warfarin tablets are taken once a day in the evening
  • Regular blood tests are required to regulate the warfarin dose.

Patients with a DVT or PE associated with cancer usually remain on LMW heparin for the duration of the treatment period.

If Low Molecular Weight (LMW) Heparin is required:

Enoxaparin and Dalteparin are both available

  • Treatment is given subcutaneously.
  • Treatment is given once (1.5 mg/kg od) or twice a day (1 mg/kg bid).
  • The dose is reduced if renal function is reduced (1mg/kg od).