1.1. Adults
Low-molecular-weight heparins (LMWH) are FDA-approved in adults to prevent deep vein thrombosis (DVT) in patients undergoing abdominal surgery, hip replacement surgery, as well as those medical patients with acute illness and severely limited mobility, and prevent ischemic complications of unstable angina and non-Q-wave myocardial infarction1-4. Enoxaparin is also indicated to prevent DVT in patients requiring knee replacement surgery, treat inpatient DVT with or without pulmonary embolism (PE), treat outpatient acute DVT without PE, and treat acute ST-segment elevation myocardial infarction (STEMI) in patients managed medically or with subsequent percutaneous coronary intervention, while dalteparin is FDA-approved to treat venous thromboembolism (VTE) to reduce recurrence in cancer patients1-4. However, dalteparin is not FDA-approved to treat acute venous thromboembolism in adults1,2,4. Adult dosages are dependent upon therapeutic diagnosis, body weight, and renal function and are summarized in Table 1. In some circumstances (e.g., weight-based dosages), maximum daily dosages are not readily identifiable.
| Treatment Indication | Drug Name | Maximum Recommended Dosage - Standard | Maximum Recommended Dosage - Severe Renal Impairment (CrCl less than 30 ml/min) |
|---|---|---|---|
| Deep vein thrombosis (DVT)/pulmonary embolus (PE) prophylaxis for hip replacement surgery | Enoxaparin (Lovenox®) | 30 mg SC every 12 hours or 40 mg subcutaneously (SC) once daily | 30 mg SC once daily |
| Deep vein thrombosis (DVT)/pulmonary embolus (PE) prophylaxis for hip replacement surgery | Dalteparin (Fragmin®) | 5000 IU SC once daily | --- |
| DVT/PE prophylaxis for knee replacement surgery | Enoxaparin | 30 mg SC every 12 hours | 30 mg SC once daily |
| DVT/PE prophylaxis for abdominal surgery | Enoxaparin | 40 mg SC once daily | 30 mg SC once daily |
| DVT/PE prophylaxis for abdominal surgery | Dalteparin |
moderate risk: 2500 IU SC once daily high risk: 5000 IU SC once daily |
--- |
| DVT prophylaxis for acute illness and significantly limited mobility | Enoxaparin | 40 mg SC once daily | 30 mg SC once daily |
| DVT prophylaxis for acute illness and significantly limited mobility | Dalteparin | 5000 IU SC once daily | --- |
| Outpatient DVT treatment without PE, co-administered with warfarin | Enoxaparin | 1 mg/kg SC every 12 hours | 1 mg/kg SC once daily |
| DVT/PE treatment in cancer patients | Dalteparin |
month 1: 200 IU/kg SC once daily month 2-6: 150 IU/kg SC once daily (maximum total daily dose = 18,000 IU) |
---* |
| Inpatient DVT treatment with or without PE, co-administered with warfarin | Enoxaparin | 1 mg/kg SC every 12 hours or 1.5 mg/kg SC daily | 1 mg/kg SC once daily |
| Unstable angina/non-Q-wave myocardial infarction (MI), when co-administered with aspirin | Enoxaparin | 1 mg/kg SC every 12 hours | 1 mg/kg SC once daily |
| Unstable angina/non-Q-wave myocardial infarction (MI), when co-administered with aspirin | Dalteparin | 120 IU/kg SC every 12 hours (maximum single dose = 10,000 units) | --- |
| Acute STEMI | Enoxaparin | Less than 75 years: 30 mg IV bolus x 1 + 1 mg/kg SC, followed by 1 mg/kg SC every 12 hours with aspirin | 30 mg IV bolus x1 + 1 mg/kg SC, followed by 1 mg/kg SC once daily with aspirin |
| Acute STEMI | Enoxaparin | Greater than or equal to 75 years: 0.75 mg/kg SC every 12 hours with aspirin (no bolus) | 1 mg/kg SC once daily with aspirin (no bolus) |
Legend:
- * In severe renal impairment in cancer patients, monitor anti-Xa levels to determine dalteparin dose necessary to achieve anti-Xa levels in the range of 0.5 to 1.5 IU/ml.