Table 3. Target INR for Venous Thromboembolism. Deep Vein Thrombosis (DVT) and Pulmonary Emboli (PE)
Adapt From ANTITHROMBOTIC AND THROMBOLYTIC THERAPY, 8TH ED: ACCP GUIDELINES : Executive Summary
Jack Hirsh, Gordon Guyatt, Gregory W. Albers, Robert Harrington and Holger J. Schünemann
Chest June 2008 133 : 71S - 109S ; doi:10.1378/chest.08-0693
. INRDURATION ALTERNATIVE
Secondary (reversable cause) deep vein thrombosis (DVT) or pulmonary emboli (PE). First episode
2.0-3.03 months . Idiopathic DVT or PE. First episode
May consider long-term, particularly proximal DVT Idiopathic DVT or PE. Second episode 2.0-3.0
3 months for distal DVT DVT or PE with cancer 2.0-3.0
Until cancer is resolved
LMWH for the first 3-6 months DVT or PE with antiphospholipid antibodies. First episode 2.0-3.0
May consider long- term DVT or PE with deficiency of coagulation factors *. First episode 2.0-3.0
May consider long-term Recurrent episodes of DVT or PE 2.0-3.0
For Pacific-Asian (exclude caucasian in this region), The INR range of 2.0-3.0 and 2.5-3.5 may be substituted with INR range of 1.6-2.6 and 2.0-3.0 respectively (Requires more validation)
- Start heparin with warfarin. Prefer Low molecular weight heparin (LMWH) over Unfractionated heparin (UFH).
- Discontinue heparin 2 days after target INR has reached.
- May use thrombolytic treatment in massive or life threatening pulmonary emboli.
- Duration of 12 months or more in cases of recurrent VTE, cancer, antithrombin deficiency, antithrombin antibody syndrome, protein C or protein S deficiency,
- * = multiple thrombophilic conditions, antithrombin deficiency, antithrombin antibody syndrome, protein C or protein S deficiency, hemocystienemia, homozygous factor V Leidin.
- Insert inferior vena caval filter in cases of high risk of VTE and cannot use anticoagulation, recurrent VTE or pulmonary emboli with pulmonary hypertension despite adequate anticoagulation.