Treatment Of VTE
The duration of treatment (anticoagulation) depends on the cause of VTE: 3 months for CVC-related or secondary VTE and 6 months for idiopathic or recurrent VTE. Initial anticoagulation with LMWH or UFH for 5–10 days followed by maintenance warfarin or LMWH. Routine use of thrombolytic therapy is not recommended unless there is a major vessel occlusion. Protamine sulphate can be used to reverse th
The duration of treatment (anticoagulation) depends on the cause of VTE: 3 months for CVC-related or secondary VTE and 6 months for idiopathic or recurrent VTE. Initial anticoagulation with LMWH or UFH for 5–10 days followed by maintenance warfarin or LMWH. Routine use of thrombolytic therapy is not recommended unless there is a major vessel occlusion. Protamine sulphate can be used to reverse the effects of both LMWH and UFH.
| Drug | Dose | Comments |
| Low Molecular Weight Heparin (LMWH), e.g. enoxaparin. |
< 2 months of age: 1.5 mg/kg/dose, SC, 12 hourly. > 2 months of age: 1 mg/kg/dose, SC, 12 hourly. |
Avoid with renal insufficiency. Monitoring: 0.5–1.0 antiXa U/mL (sample must be drawn in a non-heparinised syringe, 3– 4 hours post dose). |
| Unfractionated Heparin (UFH). | Bolus: 75– 100 units/kg, IV, followed by 20 units/kg/hour, IV, as a continuous infusion. |
Monitoring: PTT 2–3 times baseline value (60–85 seconds). Check platelet count (heparin induced thrombocytopenia is an infrequent complication). |
| Warfarin | 0.1 mg/kg (maximum 10 mg on day 1). | Must follow treatment with a heparin. Dose can be increased by 0.5 mg per dose, in response to INR (target 2.0–3.0). Heparin is discontinued when warfarin produces target INR for 2 consecutive days. Monitoring: INR at least 2–4 weekly. |
Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter 23: Paediatric Intensive Care, 23.9 Venous Thrombo-embolism (VTE), 23.9.2 Treatment of VTE