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Treatment Protocol

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Protocol for the Home Treatment of Proximal Deep-Vein Thrombosis
with Subcutaneous Low-Molecular Weight Heparin

1. Day One
   1. Medications:
      1. Start the patient on Lovenox* (enoxaparin sodium) 1 mg/kg SQ BID or Lovenox 1.5 mg/kg SQ QD, plus warfarin 5mg PO QD. Note that starting dose may be lower in elderly patients or patients with hepatic disease.
      2. Educate patient and family member about supportive care responsibilities, indications, administration, side effects, and drug/food interactions that are associated with the prescribed medications.
      3. Instruct patient to visit laboratory to obtain aPTT, PT/INR, and CBC with platelet count if warranted, or arrange for home-based testing.
   2. Patient activity:
      1. Elevation of the affected extremity may be beneficial.
      2. Local heat may improve microcirculation.
      3. Perform range-of-motion or recommended exercises.
      4. Limit physical activity if painful.

2. Day Two
   1. Medications:
      1. Continue medications.
      2. Perform a brief physical exam and assess for bleeding complications.
      3. Reinforce correct Lovenox administration technique, and medication compliance.

3. Days Three through Seven
   1. Medications:
      1. Continue medications.
      2. Obtain PT/INR and adjust warfarin dose as necessary to achieve an INR between 2 and 3.
      3. Continue patient or caregiver education regarding the indications, administration, side effects, and drug/food interactions that are associated with medications.
      4. Instruct patient to visit laboratory to obtain aPTT, PT/INR, and CBC with platelet count if warranted, or continue home-based testing.