UAMS Therapeutics Anticoagulation Doses
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| dalteparin (Fragmin) inpatient VTE tx | 100 u/kg BID
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| dalteparin (Fragmin) Unstable angina/NQWMI tx | 120 u/kg BID with aspirin (but not more than 10,000 u SC Q 12 hr)
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| 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
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| enoxaparin outpatient VTE tx | 1 mg/kg BID at least 5 days and until INR=2-3Renal dosing is 1 mg/kg daily
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| enoxaparin Unstable angina/NQWMI tx | 1 mg/kg BID with ASA
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| 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
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| 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
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| tinzaparin (Innohep) inpatient VTE tx | 175 u/kg daily
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| daltaparin VTE prophylaxis after hip repl. surgery | 2500 u SC 4-8 hr after surgery, then 5000 U daily SC
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| daltaparin VTE prophylaxis after abdominal surgery | 2500 u SC daily starting 1-2 hr before surgery (5000 u if high risk)
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| daltaparin VTE prophylaxis in medically ill | 5000 u SC daily for 12-14 days
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| daltaparin VTE prophylaxis in cancer | 5000 u SC daily
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| 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
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| enoxaparin prophylaxis renal dosing | 30 mg SC daily
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| 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
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| enoxaparin VTE prophylaxis after abdominal surgery | 40 mg SC daily, first dose 2 hr before surgery, continue 7-10 days, up to 12 days
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| enoxaparin VTE prophylaxis in medically ill | 40 mg SC Q 24 hr
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| enoxaparin VTE prophylaxis in cancer | 40 mg SC daily
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| fondaparinux prophylaxis | 2.5 mg SC daily 6-24 hr after surgery
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| fondaparinux VTE tx | 7.5 mg for pt 50-100 kg5 mg for pt <50 kg10 mg for pt >100 kg
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| fondaparinux ACS tx | 2.5 mg SC daily
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| 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
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| 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
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