Table 7 Dosing regimens for prophylaxis and treatment of VTE in patients with cancer [8]

Pharmacologic (anticoagulant) prophylaxis

 Hospitalized medical patients

  Unfractionated heparin

5,000 U once every 8 h sc

  Dalteparin

5,000 U once daily

  Enoxaparin

40 mg once daily

  Fondaparinux

2.5 mg once daily

 Surgical patients

  Unfractionated heparin

5,000 U 2 to 4 h preoperatively and once every 8 h sc thereafter or 5,000 U 10 to 12 h preoperatively and 5,000 U once daily thereafter

  Dalteparin

2,500 U 2 to 4 h preoperatively and 5,000 U once daily thereafter or 5,000 U 10 to 12 h preoperatively and 5,000 U once daily thereafter

  Enoxaparin

20 mg 2 to 4 h preoperatively and 40 mg once daily thereafter or 40 mg 10 to 12 h preoperatively and 40 mg once daily thereafter

  Fondaparinux

2.5 mg beginning 6 to 8 h postoperatively

Treatment of established VTE

 Initial

  Unfractionated heparin

80 U/kg IV bolus, then 18 U/kg per hour IV

  Dalteparin

100 U/kg once every 12 h; 200 U/kg once daily

  Enoxaparin

1 mg/kg once every 12 h; 1.5 mg/kg once daily

  Tinzaparin

175 U/kg once per day

  Fondaparinux

50 kg, 5.0 mg once daily; 50 to 100 kg, 7.5 mg once daily; 100 kg, 10 mg once daily

 Long term

  Dalteparin

200 U/kg once daily for 1 month, then 150 U/kg once daily

  Enoxaparinijk

1.5 mg/kg once daily; 1 mg/kg once every 12 h

  Tinzaparin

175 U/kg once daily

  Warfarin

Adjust dose to maintain INR 2 to 3