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Pulmonary embolism// DVT
Dr.Muhammad Farrukh Bhatti, 4 years ago 1 RepliesIf a patient who is a known case of DVT and on lifelong anticoagulation with tab.rivaroxabn develops pulmonary embolism what will be his longterm management.
Is this patient anticoagulation should be. shifted to Warfarin?
Recurrent thrombosis despite treatment with oral NOAC can occur in the following situations:
- Non-compliance to treatment
- Using locally manufactured sub-standard brands of oral NOACs
- Obese patients with a BMI exceeding 40 kg/m² or weight of the patients exceeding 120 Kgs.
- Patients with Antiphospholipid syndrome.
In the acute emergency settings, switch to LMWH for a month or so. This should be followed by switching to and overlapping with warfarin until the INR is achieved. It is also important to keep the INR in a slightly above normal ranges i.e. 2.5 to 3.5 and in some cases 3 to 4. especially if the patient develops thrombosis despite the target INR.