Hospitalized medical patients | Surgical patients (postoperative dosing*) | |
Unfractionated heparin | ||
Unfractionated heparin |
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Low molecular weight (LMW) heparin | ||
Dalteparin |
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|
Enoxaparin |
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|
NadroparinΔ |
|
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TinzaparinΔ |
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Fondaparinux | ||
Fondaparinux |
|
|
These doses apply to VTE prophylaxis (not treatment) and are appropriate for adults with active cancer. Administration is by subcutaneous injection for all agents listed. Dose adjustments may be required for kidney impairment or high body mass index. For dose adjustments, refer to separate tables in UpToDate and UpToDate Lexidrug monographs. Anti-Xa units should be calibrated to the specific product.
For surgical patients, some surgeons will start prophylaxis preoperatively, depending on the specific procedure, bleeding risk, and thrombosis risk. Refer to UpToDate topics on VTE prevention in patients with cancer for further information including suggested duration of thromboprophylaxis and use of parenteral as well as oral anticoagulants.VTE: venous thromboembolism.
* Preoperative dosing may be appropriate in selected settings provided there is no concern about bleeding with anticoagulation (eg, due to neuraxial anesthesia or spine surgery). Refer to UpToDate for details of anticoagulation management in individuals undergoing neuraxial anesthesia or procedures involving the central nervous system.
¶ The standard unfractionated heparin dosing interval for VTE prophylaxis is once every 8 hours. In low weight patients (eg, <50 kg) standard dosing may result in overexposure and increased anticoagulant effect; consider an interval of once every 12 hour dosing in such patients.
Δ Not available in the United States.