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Anticoagulation Dose

UAMS Therapeutics Anticoagulation Doses

QuestionAnswer
dalteparin (Fragmin) inpatient VTE tx 100 u/kg BID
dalteparin (Fragmin) Unstable angina/NQWMI tx 120 u/kg BID with aspirin (but not more than 10,000 u SC Q 12 hr)
enoxaparin (Lovenox) inpatient VTI tx 1 mg/kg BID or 1.5 mf/kg daily SC at least 5 days with warfarin and until INR=2-3Renal dosing is 1 mg/kg daily
enoxaparin outpatient VTE tx 1 mg/kg BID at least 5 days and until INR=2-3Renal dosing is 1 mg/kg daily
enoxaparin Unstable angina/NQWMI tx 1 mg/kg BID with ASA
enoxaparin STEMI tx <75 y/o: 30 mg single IV bolus plus a 1 mg/kg SC dose, then 1 mg/kg SC Q 12 hr with ASA>75 y/o: 0.75 mg/kg SC Q 12 hr, no bolus
enoxaparin STEMI tx renal dosing <75 y/o: 30 mg single IV bolus plus a 1 mg/kg SC dose, then 1 mg/kg SC daily>75 y/o: 0.75 mg/kg SC daily, no bolus
tinzaparin (Innohep) inpatient VTE tx 175 u/kg daily
daltaparin VTE prophylaxis after hip repl. surgery 2500 u SC 4-8 hr after surgery, then 5000 U daily SC
daltaparin VTE prophylaxis after abdominal surgery 2500 u SC daily starting 1-2 hr before surgery (5000 u if high risk)
daltaparin VTE prophylaxis in medically ill 5000 u SC daily for 12-14 days
daltaparin VTE prophylaxis in cancer 5000 u SC daily
enoxaparin VTE prophylaxis after hip repl. surgery 30 mg SC Q 12 hr, first dose 12-24 hr after surgery, continue 7-10 days OR 40 mg Q 24 hr beginning 9-15 hr before surgery, continue 40 mg SC daily for 3 weeks for a total period of 4 weeks
enoxaparin prophylaxis renal dosing 30 mg SC daily
enoxaparin VTE prophylaxis after knee surgery 30 mg SC Q 12 hr, first dose 12-24 hr after surgery, continue 7-10 days, up to 14 days
enoxaparin VTE prophylaxis after abdominal surgery 40 mg SC daily, first dose 2 hr before surgery, continue 7-10 days, up to 12 days
enoxaparin VTE prophylaxis in medically ill 40 mg SC Q 24 hr
enoxaparin VTE prophylaxis in cancer 40 mg SC daily
fondaparinux prophylaxis 2.5 mg SC daily 6-24 hr after surgery
fondaparinux VTE tx 7.5 mg for pt 50-100 kg5 mg for pt <50 kg10 mg for pt >100 kg
fondaparinux ACS tx 2.5 mg SC daily
heparin initial tx of acute DVT in the leg 80 u/kg bolus or 5000 u bolus, then IV starting at 18 u/kg/hr or 1300 u/hrSC UFH starting at 17,500 u or 250 u/kg BID
fondaparinux initial tx of acute DVT in the leg SC 7.5 mg if pt 50-100 kg, 5 mg if <50 kg, 10 mg if >100 kg
Created by: jmhernandez