A 41 year old female patient is an inpatient on the haematology ward progressing through her first cycle of the UKALL14 protocol for a new diagnosis of ALL. She complains of a swollen and painful left arm, and US confirms a DVT at the sight of her PICC line.
FBC: Hb 81, WCC 2.1, Plt 21
How would you manage her anticoagulation?
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