(Low Molecular Weight Heparins) LMWH's

Thrombocytopenia incidence: LMWH's: 0.6% Unfractionated heparin: 3.5%
Protein binding: LMWH's: Low Unfractionated heparin: high

dalteparin (Fragmin ®):

DVT prophylaxis, abdominal surgery: 2,500 units 1-2 hours preop and once daily postop x 5-10 days (High risk patients (e.g. malignancy): 5000 units SC 1-2 hrs prior to surgery and then qd x 5-10 days.)
Prophylaxis (hip replacement): 2500 units 4-8 hrs postop, then 5000 units qd x 5-10 days (up to 14 days). Start at least 6hr after postop dose. Alternatively: 5000 units 10-14hrs preop and 4-8hrs postop. Maint: 5000 units qd up to 14 days.

Unstable angina, non-Q-wave MI: 120 units/kg up to 10,000 units SC every 12 hours with aspirin (75-165mg) until stable.
DVT treatment (not FDA approved): Dosing: 200 IU/kg SC qd (Max: 18,000 units/day)

danaparoid (Orgaran ®):

Removed from the market

enoxaparin (Lovenox ®):

DVT prophylaxis (hip / knee surgery): 30 mg SC every 12 hours starting 12-24 hours postop. Alternative for hip: 40 mg SC once daily starting 12 hours preop.
DVT treatment (Outpatient): 1 mg/kg SC every 12 hours until oral anticoagulation established.
DVT treatment (Inpatient): 1 mg/kg SC every 12 hours or 1.5 mg/kg SC once daily.
Unstable angina or non-Q-wave MI: 1 mg/kg SC every 12 hours

Prophylaxis in acute medically ill patients (high risk): 40 mg SC qd x 6-11 days (up to 14 days).

tinzaparin (Innohep ®):

Prevention of deep vein thrombosis, general surgery: 3500 units anti-Xa SC qd x 5-10 days.
Prevention of deep vein thrombosis, orthopedic surgery: 50 units anti-Xa/kg SC qd.
Treatment of deep vein thrombosis / PE: 175 units anti-Xa/kg SC qd for at least 6 days and until the patient is adequately anticoagulated with warfarin (INR of 2 for at least 2 days)

Factor Xa Inhibitors

fondaparinux (Arixtra ®):

Synthetic pentasaccharide that causes an antithrombin III-mediated selective inhibition of factor Xa.
DVT prophylaxis: (patients > 50kg): 2.5 mg SC once daily (After hemostasis has been established, the initial dose should be given 6 to 8 hours after surgery. ) Usual duration: 5-9 days (up to 10 days following abdominal surgery or up to 11 days following hip replacement or knee replacement). Extended prophylaxis is recommended following hip fracture surgery.

Acute DVT/PE treatment:
<50 kg: 5 mg once daily
50-100 kg: 7.5 mg once daily
>100 kg: 10 mg once daily
Usual duration: 5-9 days (has been administered up to 26 days)

Renal Dosing:
[crcl 30 - 50 ml/min]: Use caution
[<30 ml/min]: Contraindicated
Supplied: Syringe: 2.5 mg/0.5 ml, 5 mg/0.4ml, 7.5 mg/0.6 ml, 10 mg/0.8 ml

Much more selective inhibitor of factor Xa

Agent	Anti-Xa/anti-IIa ratio
UFH	1:1
LMWH	2-4:1
Danaparoid	22:1
Fondaparinux	∞

Fragmin® versus Lovenox®

Fragmin® versus Lovenox®
DVT /PE Prophylaxis
Indication	Dalteparin (Fragmin)	Enoxaparin (Lovenox)
Knee replacement surgery prophylaxis	Not FDA-approved	30mg q12h x 7-10 days
Hip replacement surgery prophylaxis	5000 IU qd x 5-10 days	30mg q12h or 40mg qd x 7-10 days
General surgery prophylaxis	Moderate risk: 2500 IU qd x 5-10 days // high-risk patients: 5000 IU qd x 5-10 days	Moderate risk: 30 mg SC qd. high-risk patients: 40mg qd x 7-10 days or 30mg SC q12h.
Orthopedic surgery	2500 units 6-8 hours postop (omit if patient received spinal anesthesia), then 5000 units SC qd.	30mg q12h or 40mg qd x 7-10 days
Abdominal Surgery	5,000 IU SC the evening prior to surgery and then once daily for 5 to 10 days	40 mg SC qd (initial dose given 2 hours prior to surgery.) Usual duration of administration: 7 to 10 days
Acute trauma or spinal injury	2500 IU bid	30 mg SC qd
Prophylaxis in acute medically ill patients (high risk)	5000 IU SC qd.	40mg SC qd x 6-11 days
DVT / PE Treatment
Treatment of DVT (with or without PE)	Not FDA-approved. // Dosing: 200 IU/kg SC qd. Alternatively (patients with hypercoagulable states or with increased risk of bleeding): 100 IU/kg SC bid. (maximum of 18,000 IU qd or 9000 IU bid.)	1 mg/kg q12h or 1.5 mg/kg qd.
Acute coronary syndrome treatment
ACS (unstable angina / non-ST segment elevation MI)	120 IU/kg q12h x 5-8 days (maximum of 10,000 IU q12h)	1 mg/kg SC q12 x 2 to 8 days

Disclaimer

Listed dosages are for - Adult patients ONLY. PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon.

David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc.

Disclaimer Contact Us Privacy Policy Website Search	We comply with the HONcode standard for health trustworthy information: Verify here. Copyright © 2007 GlobalRPh Inc.