Treatment of DVT's

Speculating · Dec 10, 2003

Originally posted by askater11
Has anyone else seen patients with I.V. access being tx. with lovenox SQ only?

There's nothing wrong with treating a DVT strictly with Lovenox. I've treated people off on on this way for well over a year. It just depends on the Dr. If you treat with heparin then you have to switch over to Warfarin, then your adjusting it to fit the INR...With Lovenox you can send them home with SQ's after a day or two. It's adjusted by poundage then your pretty much done. No need for the frequent blood draws.

galenight, BSN, RN · Dec 10, 2003

The last poster is correct. There is no delicate balance of lab values to worry about with Lovenox. Many DVT's are now being treated on an outpatient basis. This is probably due to 2 factors: The insurance companies don't want to pay for a lengthy (our average was 5 -7 days) stay; and the recommended tx is rest, anticoags, and depending on the doc, warm moist compresses. These can be done in the comfort of the patients home with or without home care assist. As an ER nurse, I don't automatically insert an IV into a suspected DVT, although I usually do and just draw blood from the site.

I think this kind of somewhat comlicated outpatient treatment is on the horizon for many many illnesses. Look for them soon in a home near you...lol

cannoli · Dec 10, 2003

This is really interesting.

Learned something new again today!

unknown99, BSN, RN · Dec 10, 2003

We routinely use Lovenox at the hospital where I work. Mostly on total joint replacements, and some M.I. patients. It cuts down hospitalization time, and is , what our docs consider, to be safer than heparin and warfarin.:) :)

FranEMTnurse, CNA, LPN, EMT-I · Dec 10, 2003

I've been getting those shots in my belly for over two years now. Every time I'm hospitalized, which is quite often. And the best part is, they don't even hurt.

Fran:)

BarbPick · Dec 10, 2003

If it is so easily handled with levanox, how come I get so many patients on heparin drips still? I work occasionally in tele and unit, and it seems like they run sales on heparin drips.Must be where the emboli can launch from...any opinion, please share. These patients seem like they could be out patients.

TIGRESS99 · Dec 10, 2003

I recently was diagnosed with a DVT (April 2003) and was placed on Lovenox SQ q12 hours for 7 days along with PO Coumadin. I was on Coumadin for 6 months and had to go in frequently at first for INR checks and then when my INR was where they wanted it, I went in once a month. They adjusted my Coumadin dosing according to the INR results. The DVT was resolved as of July but I remained on the Coumadin for the entire 6 months.

Tweety, BSN, RN · Dec 10, 2003

I've seen Lovenox exclusively used for DVT as well.

Silverdragon102, BSN · Dec 10, 2003

Here in the UK for a few years we have been using s/c heparin (cannot remember the name) initially it was given twice daily and then another s/c heparin was licenced and that was once daily, certainly made our lives a lot easier and I felt safer for the patient as the bleeding risk factor was reduced.

Anna

Jay-Jay, RN · Dec 10, 2003

We use Fragmin, which is low molecular weight heparin to manage DVT's in the community. I think that is probably the drug Silverdragon is referring to. The patients are on coumadin, too, then the Fragmin can be discontinued once the INR is in the therapeutic zone.

I had a pregnant patient with a DVT in her leg, who was on Fragmin twice a day until just before her due date. The advantage is it's very short acting, and not as likely to cause postpartum bleeding as coumadin.

Long Term Care Columnist / Guide · Dec 10, 2003

Where I work, we rarely use heparin drips anymore.....most DVT's are treated with SQ heparin or Fragmin. (We still do heparin drips on PE's though.) It's amazing; when I worked there several years ago, I usually had at least one pt. on heparin protocol, and now I've been back almost a year and haven't had a single one. The patients seem to do better with this too, as there aren't so many lab draws (they were done Q 6 hrs on heparin protocol, and sometimes people were on heparin for several days). Thank God for progress, no?

Now, if they can just do something about that gawdawful pre-endoscopy bowel prep...........