Prophylaxis of VTE in surgery Patient w/ moderate thromboembolism risk 2,000 IU SC once daily given 2 hr pre-op.
Patient w/ high thromboembolism risk 4,000 IU SC once daily given 12 hr pre-op.
Major orthopaedic surgery Extend thromboprophylaxis up to 5 wk.
Abdominal or pelvic surgery for cancer Extend thromboprophylaxis up to 4 wk.
Prophylaxis of DVT in medical patient 4,000 IU SC once daily for 6-14 days.
DVT & PE Uncomplicated patient w/ low risk of VTE recurrence 150 IU/kg SC once daily for 10 days.
Patient w/ obesity, symptomatic PE, cancer, recurrent VTE or proximal (vena iliaca) thrombosis 100 IU/kg bd for 10 days.
Prevention of thrombus formation during haemodialysis 100 IU/kg.
Patient w/ high risk of haemorrhage Reduce to 50 IU/kg for double vascular access or 75 IU/kg for single vascular access.
Unstable angina & NSTEMI 100 IU/kg SC every 12 hr for 2-8 days w/ initial PO loading dose: ASA 150-300 mg daily & maintenance dose: 75-325 mg daily.
Acute STEMI 3,000 IU single IV bolus followed by 100 IU/kg SC every 12 hr for 8 days or until hospital discharge. Max: 10,000 IU for 1st 2 SC doses. 1st dose should be administered between 15 min before & 30 min after start of fibrinolytic therapy. In combination w/ ASA: 75-325 mg daily.
Patient managed by PCI 30 IU/kg IV bolus if last SC inj was given >8 hr before balloon inflation.
Elderly ≥75 yr Acute STEMI 75 IU/kg SC every 12 hr. Max: 7,500 IU for 1st 2 SC doses.
Severe renal impairment (CrCl 15-30 mL/min) Prophylaxis of VTE 2,000 IU SC once daily.
DVT, PE, unstable angina & NSTEMI 100 IU/kg SC once daily.
Acute STEMI Patient >75 yr 100 IU/kg SC then 100 IU/kg SC every 24 hr;
<75 yr 3,000 IU IV bolus + 100 IU/kg SC then 100 IU/kg SC every 24 hr.