2. Duration of Therapy

2.1. Adults

When prescribed as preventive therapy, LMWH should be administered until the risk of deep venous thrombosis has diminished. When utilized in the management of DVT and pulmonary embolism, warfarin therapy is typically initiated within 72 hours of enoxaparin therapy. Enoxaparin is continued until a therapeutic anticoagulant effect with warfarin has been achieved^1-3 . If using Direct-Acting Oral Anticoagulant (DOAC) therapy, then LMWH is typically discontinued upon initiation of DOAC therapy^1,2,5-8. LMWH treatment duration varies with respect to therapeutic indication and is summarized in Table 3.

Table 3. LMWH Recommended Treatment Duration (Adults)^{1-4, 9-15}
Treatment Indication	Drug Name	Treatment Duration Range	Maximum Treatment Duration
DVT/PE prophylaxis for hip replacement surgery	Enoxaparin	7 to 10 days^	21 days^
DVT/PE prophylaxis for hip replacement surgery	Dalteparin	5 to 10 days	14 days^
DVT/PE prophylaxis for knee replacement surgery	Enoxaparin	7 to 10 days	14 days^
DVT/PE prophylaxis for abdominal surgery	Enoxaparin	7 to 10 days	12 days
DVT/PE prophylaxis for abdominal surgery	Dalteparin	5 to 10 days	10 days
DVT/PE prophylaxis for acute illness and significantly limited mobility	Enoxaparin	6 to 11 days	14 days
DVT/PE prophylaxis for acute illness and significantly limited mobility	Dalteparin	12 to 14 days	14 days
DVT/PE treatment in cancer patients	Dalteparin	6 months	6 months
Outpatient DVT treatment without pulmonary embolus (PE)	Enoxaparin	7 days	17 days
Inpatient DVT treatment with or without PE	Enoxaparin	7 days	17 days
Unstable angina/non-Q-wave myocardial infarction (MI)	Enoxaparin	2 to 8 days	12.5 days
Unstable angina/non-Q-wave myocardial infarction (MI)	Dalteparin	5 to 8 daysup to 8 days or hospital discharge, whichever is first	8 days
Acute STEMI	Enoxaparin		not determined

Legend:

^In patients undergoing orthopedic surgery, dalteparin and enoxaparin may be continued for 28 to 35 days¹³.

2.2. Pediatrics

Although treatment durations have not been solidified, experts recommend that dalteparin therapy should be continued for less than or equal to 3 months in pediatric patients with provoked DVT or PE and up to 12 months (range, 6 to 12 months) in pediatric patients with unprovoked DVT or PE¹⁵. Dalteparin treatment recommendations for pediatric patients are summarized in Table 4.

Table 4. LMWH Recommended Treatment Duration (Pediatric Patients) ^1,2,4,15
Treatment Indication	Drug Name	Treatment Duration Range	Maximum Treatment Duration
Venous thromboembolism treatment	Dalteparin	3 to 12 months	12 months