From the FDA Drug Label
In a multicenter, parallel group study, 900 patients with acute lower extremity deep vein thrombosis (DVT) with or without pulmonary embolism (PE) were randomized to an inpatient (hospital) treatment of either (i) Enoxaparin Sodium Injection 1. 5 mg/kg once a day subcutaneously, (ii) Enoxaparin Sodium Injection 1 mg/kg every 12 hours subcutaneously, or (iii) heparin intravenous bolus (5000 IU) followed by a continuous infusion (administered to achieve an aPTT of 55 to 85 seconds).
EINSTEIN Deep Vein Thrombosis and EINSTEIN Pulmonary Embolism Studies XARELTO for the treatment of DVT and/or PE was studied in EINSTEIN DVT [NCT00440193] and EINSTEIN PE [NCT00439777], multi-national, open-label, non-inferiority studies comparing XARELTO (at an initial dose of 15 mg twice daily with food for the first three weeks, followed by XARELTO 20 mg once daily with food) to enoxaparin 1 mg/kg twice daily for at least five days with VKA and then continued with VKA only after the target INR (2.0–3. 0) was reached.
The treatment for a non-occlusive thrombus of the right peroneal vein (peroneal vein thrombosis) may include:
- Enoxaparin Sodium Injection: 1.5 mg/kg once a day subcutaneously or 1 mg/kg every 12 hours subcutaneously 1
- Rivaroxaban (XARELTO): an initial dose of 15 mg twice daily with food for the first three weeks, followed by 20 mg once daily with food 2
- Heparin: intravenous bolus (5000 IU) followed by a continuous infusion (administered to achieve an aPTT of 55 to 85 seconds) 1 Note: The choice of treatment should be based on individual patient factors and clinical judgment.
From the Research
Treatment for a non-occlusive thrombus of the right peroneal vein typically involves anticoagulation therapy, with direct oral anticoagulants (DOACs) such as rivaroxaban or apixaban being preferred for most patients, as they have been shown to be effective in preventing recurrent venous thromboembolism (VTE) with a similar or reduced risk of bleeding compared to warfarin 3. The standard approach is to start with low molecular weight heparin (LMWH) such as enoxaparin 1 mg/kg twice daily subcutaneously, or fondaparinux 7.5 mg once daily subcutaneously (dose adjusted for weight and renal function), followed by oral anticoagulation. Some key points to consider in the treatment of non-occlusive thrombus of the right peroneal vein include:
- The use of LMWH, such as enoxaparin, as an initial treatment option, as it has been shown to be effective in preventing recurrent VTE and reducing the risk of bleeding 4, 5
- The use of DOACs, such as rivaroxaban or apixaban, as a preferred option for most patients, due to their ease of use and reduced risk of bleeding compared to warfarin 3, 6
- The importance of regular follow-up to monitor for bleeding complications, assess treatment efficacy, and determine the appropriate duration of therapy based on risk factors for recurrence
- The use of compression stockings (20-30 mmHg) to help reduce swelling and pain, and encouraging patients to ambulate as tolerated rather than remain immobile Treatment duration is typically 3 months for a provoked DVT (with a clear triggering factor) or at least 6-12 months for unprovoked cases. It is also important to note that the choice of anticoagulant should be individualized based on patient-specific factors, such as renal function, liver function, and the presence of any contraindications to anticoagulation. In cases where the initial anticoagulant therapy fails, the optimal choice of subsequent anticoagulant is unclear, and the decision should be made on a case-by-case basis, taking into account the patient's individual risk factors and medical history 7.