LMWHs and the recommended doses for the treatment of acute VTE | |
LMWH | Treatment dose |
Enoxaparin (20, 40, and 60 mg prefilled syringes) | 1 mg/kg twice daily |
Tinzaparin (0.5 and 0.7 mL of 20,000 anti-Xa IU/mL prefilled syringes) | 175 units/kg once daily A simple way to calculate tinzaparin dose: Volume of tinzaparin in mL required = (weight in Kg - 10) ÷ 100 e.g. 60 kg patient = 0.5 mL; 70 kg = 0.6 mL; 45 kg = 0.35 mL tinzaparin) |
The recommended doses for fondaparinux in the treatment of acute VTE | |
Body weight, kg | Dosing, mg |
< 50 | 5 |
50 - 100 | 7.5 |
>100 | 10 |
Management with IV UFH | ||
Initial dose | 80 IU/kg bolus, then 18 IU/kg/h | |
APTT ratio | Action and Dose change | Next APTT |
<1.2 (APTT <35s) | 80 IU/kg bolus, then increase rate by 4 IU/kg/h | 6 h |
1.2 - 1.5 (APTT 35 to 45s) | 40 IU/kg bolus, then increase infusion rate by 2 IU/kg/h | 6 h |
1.5 - 2.5 (APTT 46 to 70s) | No change | 24 h |
2.5 - 3.0 (APTT 71 to 90s) | Decrease infusion rate by 2 IU/kg/h | 6 h |
>3.0 (APTT >90s) | Withold infusion for 1 hour, then decrease infusion rate by 3 IU/kg/h | 6 h |