Usual Adult Dose for Myocardial Infarction

120 international units/kg of body weight subcutaneously every 12 hours with concurrent oral aspirin (75 to 165 mg once a day) therapy

Maximum dose: 10,000 international units subcutaneously every 12 hours

Duration of therapy: Continue treatment until clinically stable; usual duration of 5 to 8 days.

Comments: Concurrent aspirin therapy is recommended unless contraindicated.

Use: Prophylaxis of ischemic complications in unstable angina and non-Q-wave myocardial infarction, when concurrently administered with aspirin therapy.

Usual Adult Dose for Angina Pectoris

120 international units/kg of body weight subcutaneously every 12 hours with concurrent oral aspirin (75 to 165 mg once a day) therapy

Maximum dose: 10,000 international units subcutaneously every 12 hours

Duration of therapy: Continue treatment until clinically stable; usual duration of 5 to 8 days.

Comments: Concurrent aspirin therapy is recommended unless contraindicated.

Use: Prophylaxis of ischemic complications in unstable angina and non-Q-wave myocardial infarction, when concurrently administered with aspirin therapy.

Usual Adult Dose for Deep Vein Thrombosis Prophylaxis after Hip Replacement Surgery

Preoperative start (evening before surgery; allow approximately 24 hours between doses):
5000 international units subcutaneously 10 to 14 hours before surgery
5000 international units subcutaneously 4 to 8 hours after surgery or later if hemostasis has not been achieved
5000 international units subcutaneously once a day during postoperative period

Preoperative start (day of surgery):
2500 international units subcutaneously within 2 hours before surgery
2500 international units subcutaneously 4 to 8 hours after surgery or later if hemostasis has not been achieved; allow a minimum of 6 hours between this dose and the dose to be given on postoperative day 1 and adjust the timing of the dose on postoperative day 1 accordingly
5000 international units subcutaneously once a day during postoperative period

Postoperative start:
2500 international units subcutaneously 4 to 8 hours after surgery or later if hemostasis has not been achieved; allow a minimum of 6 hours between this dose and the dose to be given on postoperative day 1 and adjust the timing of the dose on postoperative day 1 accordingly
5000 international units subcutaneously once a day during postoperative period

Duration of therapy: Usually 5 to 10 days after surgery; up to 14 days has been well tolerated.

Use: Prophylaxis of deep vein thrombosis (DVT), which may lead to pulmonary embolism (PE) in patients undergoing hip replacement surgery.

Usual Adult Dose for Deep Vein Thrombosis Prophylaxis after Abdominal Surgery

Moderate risk of thromboembolic complications: 2500 international units subcutaneously once a day, starting 1 to 2 hours prior to surgery and repeated once a day postoperatively.

High risk of thromboembolic complications (e.g., malignant disorder): 5000 international units subcutaneously the evening before surgery and once a day postoperatively OR 2500 international units subcutaneously 1 to 2 hours before surgery followed 2500 international units subcutaneously 12 hours later and then 5000 international units subcutaneously once a day postoperatively.

Duration of therapy: Usually 5 to 10 days

Use: Prophylaxis of DVT, which may lead to PE in patients undergoing abdominal surgery who are at risk for thromboembolic complications.

Usual Adult Dose for Deep Vein Thrombosis - Prophylaxis

5000 international units subcutaneously once a day

Duration of therapy: Usually 12 to 14 days

Use: Prophylaxis of DVT, which may lead to PE in medical patients who are at risk for thromboembolic complications due to severely restricted mobility during acute illness.

Usual Adult Dose for Venous Thromboembolism

200 international units/kg total body weight subcutaneously once a day for the first 30 days; 150 international units/kg total body weight subcutaneously once a day for months 2 through 6

Maximum dose: 18,000 international units/day

Duration of therapy: 6 months

Comments:

• In patients with CrCl less than 30 mL/min, monitor anti-Xa levels to determine dose (target anti-Xa range is 0.5 to 1.5 international units/mL); sample 4 to 6 hours after dosing and only after the patient has received 3 to 4 doses.
• Dose to be administered by patient weight during first month: 56 kg or less: 10,000 international units; 57 to 68 kg: 12,500 international units; 69 to 82 kg: 15,000 international units; 83 kg or greater: 18,000 international units.
• Dose to be administered by patient weight during months 2 through 6: 56 kg or less: 7500 international units; 57 to 68 kg: 10,000 international units; 69 to 82 kg: 12,500 international units; 83 to 98 kg: 15,000; 99 kg or greater: 18,000 international units.
• Safety and efficacy beyond 6 months have not been evaluated in cancer patients with acute symptomatic venous thromboembolism (VTE).

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Dose Adjustments

Cancer Patients with Acute Symptomatic Venous Thromboembolism (VTE):

• Platelets 50,000 to 100,000/mm3: Reduce dose by 2500 international units until platelets increase to 100,000/mm3 or greater
• Platelets less than 50,000/mm3: Discontinue therapy until platelets increase above 50,000/mm3

Precautions

US BOXED WARNINGS:

• SPINAL/EPIDURAL HEMATOMAS: Epidural or spinal hematomas, which could lead to long-term or permanent paralysis, may occur in patients who are anticoagulated with low molecular weight heparins (LMWH) or heparinoids and are receiving neuraxial anesthesia or spinal puncture. Factors that can increase the risk of developing epidural or spinal hematomas in these patients include indwelling epidural catheters, concomitant use of other drugs that affect hemostasis (e.g., non-steroidal anti-inflammatory drugs [NSAIDs], platelet inhibitors, and other anticoagulants), a history of traumatic or repeated epidural or spinal punctures, and a history of spinal deformity or surgery. Optimal timing between the administration of this drug and neuraxial procedures remains unknown. Monitor patients frequently for signs and symptoms of neurological impairment. If neurological compromise is noted, urgent treatment is necessary. Consider the benefits and risks before neuraxial intervention in patients anticoagulated or to be anticoagulated for thromboprophylaxis.

Dialysis

Data not available

Other Comments

Administration advice:

• The manufacturer product information should be consulted.

• Do not mix with other injections or infusions unless supporting data is available.

• Routine coagulation tests such as Prothrombin Time (PT) and Activated Partial Thromboplastin Time (APTT) are unsuitable for monitoring the anticoagulant effect of this drug.