Transcription of LOW MOLECULAR WEIGHT HEPARIN THERAPEUTIC …
1 LOW MOLECULAR WEIGHT HEPARIN DOSING recommendations . CLINICAL SCENARIO LMWH DOSING recommendations . ENOXAPARIN DALTEPARIN. (preferred LMWH) (no dose-capping). VTE prophylaxis . Orthopedic surgery 30mg q12h 5000 units daily (hip/knee replacement, hip fracture). Trauma 30mg q12h 5000 units daily Acute Spinal cord injury 30mg q12h 5000 units daily Acute medical illness 40mg daily 5000 units daily General surgery 40mg daily 5000 units daily Bariatric surgery 40mg q12h Not recommended Morbid obesity 40mg q12h Not recommended (BMI>40). Severe renal impairment 30mg daily 5000 units daily (Clcr < 30). VTE TREATMENT Use total body WEIGHT (TBW) to calculate dosing 1 2. Venous thrombosis 1mg/kg SQ q12h 200 units/kg daily (LMWH for a minimum of 5 days). 2. Cancer-associated venous thrombosis Dalteparin preferred, or enoxaparin 200 units/kg daily x 1 month, 1 2. (LMWH for a minimum of 3-6 months) 1mg/kg q12h x 1 month, then 150 units/kg daily 1. then mg/kg daily 1 3. Pregnancy 1mg/kg q12h 100 units/kg q12h 1 4.
2 Low body WEIGHT 1mg/kg q12h 200 units/kg daily (wt < 45 kg). 1 3. Obesity 1mg/kg q12h 100 units/kg q12h (wt > 99kg). 1 2. Moderate renal impairment q12h 200 units/kg daily (Clcr 30-60). 1. Severe renal impairment UFH preferred, or 1mg/kg daily Not recommended (Clcr<30). ACUTE CORONARY SYNDROME Use TBW to calculate dosing 1 3. Unstable angina/NQWMI 1mg/kg q12h 120 units/kg q12h Renal Impairment (Clcr<60) UFH preferred UFH preferred BRIDGE THERAPY Use TBW to calculate dosing. UFH preferred, or: 1 3. Atrial fibrillation 1mg/kg q12h 100 Units/kg q12 hrs 1 3. Heart valve replacement 1mg/kg q12h 100 Units/kg q12 hrs 1 2. History of VTE 1mg/kg q12h 200 units/kg daily 1 3. Pregnancy 1mg/kg q12h 100 units/kg q12 hrs 1 4. Low body WEIGHT 1mg/kg q12h 100 units/kg q12 hrs (wt < 45 kg). 1 3. Obesity 1mg/kg q12h 100 units/kg q12 hrs (wt > 99kg). 1 3. Moderate renal impairment q12h 100 units/kg q12 hrs (Clcr 30-60). 1. Severe renal impairment UFH preferred, or 1mg/kg q24h Not recommended (Clcr<30).
3 1 2 3 4. rounded to nearest 10mg rounded to nearest syringe size rounded to nearest 100 units rounded to nearest 500 units (see below) (use 25,000 unit/ml MDV) (use 10,000 unit/ml graduated syringe). DALTEPARIN DOSING PER TOTAL BODY WEIGHT . TBW Recommended syringe size Recommended syringe size (kg) for 200 U/kg daily dose* for 150 U/kg daily dose 4 4. < 45 kg 200 units/kg SQ daily 150 units/kg SQ daily 46 -56 10,000 units/1ml (graduated) 7500 (not graduated). 57-68 12,500 (not graduated) 10,000 units/1ml (graduated). 69-82 15,000 (not graduated) (not graduated). 83-98 18,000 (not graduated) 15,000 (not graduated). 2 2. >99 kg 100 units/kg SQ q12h 150 units/kg SQ daily University of Washington Medical Center Anticoagulation Services March 2013.
