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

From: Venous thromboembolism in cancer patients: an underestimated major health problem

  Dose
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