Prophylaxis of DVT/PE (non-HIT patients)

• SUBQ (Adults ): 750 anti-Xa units every 12 hr starting 1—4 hr preoperatively and ≥2 hr postoperatively for 7—10 days or until ambulatory (up to 14 days). Following orthopedic, major abdominal surgery, and thoracic surgery: 750 anti-Xa units, twice daily up to 14 days; initiate 1—4 hr preoperatively.
• IV SUBQ (Adults ): Nonhemorrhagic stroke: Up to 1000 anti-Xa units IV, followed by 750 anti-Xa units SUBQ twice daily for 7—14 days.

HIT

• IV SUBQ (Adults ): DVT/PE prophylaxis, current HIT, >90 kg: 1250 anti-Xa units SUBQ 2—3 times daily for 7—10 days (initial bolus of 1250 anti-Xa units IV may be used); DVT/PE prophylaxis, current HIT, ≤90 kg: 750 anti-Xa units SUBQ 2—3 times daily for 7—10 days (initial bolus of 1250 anti-Xa units IV may be used); DVT/PE prophylaxis, past (>3 mo) HIT, >90 kg: 750 anti-Xa units SUBQ 3 times daily OR 1250 anti-Xa units SUBQ twice daily for 7—10 days; DVT/PE prophylaxis, past (>3 mo) HIT, ≤90 kg: 750 anti-Xa units SUBQ 2—3 times daily for 7—10 days; DVT/PE treatment, thrombus <5 days, >90 kg: 3750 anti-Xa units IV bolus, then 400 anti-Xa units/hr for 4 hr, then 300 anti-Xa units/hr for 4 hr, then 150—200 anti-Xa units/hr for 5—7 days OR 1750 anti-Xa units SUBQ twice daily for 4—7 days; DVT/PE treatment, thrombus <5 days, 55—90 kg: 2250—2500 anti-Xa units IV bolus, then 400 anti-Xa units/hr for 4 hr, then 300 anti-Xa units/hr for 4 hr, then 150—200 anti-Xa units/hr for 5—7 days OR 2000 anti-Xa units SUBQ twice daily for 4—7 days; DVT/PE treatment, thrombus <5 days, ≤55 kg: 1250—1500 anti-Xa units IV bolus, then 400 anti-Xa units/hr for 4 hr, then 300 anti-Xa units/hr for 4 hr, then 150—200 anti-Xa units/hr for 5—7 days OR 1500 anti-Xa units SUBQ twice daily for 4—7 days; DVT/PE treatment, thrombus ≥5 days, >90 kg: 1250 anti-Xa units IV bolus, then 750 anti-Xa units SUBQ 3 times daily OR 1250 anti-Xa units SUBQ 2—3 times daily; DVT/PE treatment, thrombus ≥5 days, ≤90 kg: 1250 anti-Xa units IV bolus, then 750 anti-Xa units SUBQ 2—3 times daily; Surgical prophylaxis, nonvascular surgery, >90 kg: 750 anti-Xa units SUBQ 1—4 hr before procedure; repeat ≥6 hr after procedure; then 1250 anti-Xa units SUBQ twice daily OR 750 anti-Xa units SUBQ 3 times daily for 7—10 days; Surgical prophylaxis, nonvascular surgery, ≤90 kg: 750 anti-Xa units SUBQ 1—4 hr before procedure; repeat ≥6 hr after procedure; then 750 anti-Xa units SUBQ twice daily for 7—10 days; Surgical prophylaxis, embolectomy, >90 kg: 2250—2500 anti-Xa units IV bolus before procedure, then 150—200 anti-Xa units/hr starting ≥6 hr after procedure for 5—7 days OR 750 anti-Xa units SUBQ 2—3 times daily or change to oral anticoagulant after several days; Surgical prophylaxis, embolectomy, 55—90 kg: 2250—2500 anti-Xa units IV bolus before procedure, then 1250 anti-Xa units SUBQ twice daily starting ≥6 hr after procedure, then 750 anti-Xa units SUBQ 2—3 times daily or change to oral anticoagulant after several days; Cardiac catheterization, >90 kg: 3750 anti-Xa units IV bolus before procedure; Cardiac catheterization, <90 kg: 2500 anti-Xa units IV bolus before procedure; Percutaneous transluminal coronary angioplasty: 2500 anti-Xa units IV bolus before procedure, then 150—200 anti-Xa units/hr for 1—2 days after procedure; may receive 750 anti-Xa units SUBQ 2—3 times daily or oral anticoagulant after several days of IV therapy; Intra-aortic balloon pump catheterization, >90 kg: 3750 anti-Xa units IV bolus before procedure, then 150—200 anti-Xa units/hr or a 2nd bolus of 1250 anti-Xa units IV OR 750 anti-Xa units SUBQ 2—3 times daily OR 1250 anti-Xa units SUBQ twice daily; Intra-aortic balloon pump catheterization, <90 kg: 2500 anti-Xa units IV bolus before procedure, then 150—200 anti-Xa units/hr or a 2nd bolus of 1250 anti-Xa units IV OR 750 anti-Xa units SUBQ 2—3 times daily OR 1250 anti-Xa units SUBQ twice daily; Peripheral vascular bypass: 2250—2500 anti-Xa units IV bolus before procedure, then 150—200 anti-Xa units/hr started ≥6 hr after procedure for 5—7 days OR 750 anti-Xa units SUBQ 2—3 times daily or change to oral anticoagulant; Cardiopulmonary bypass:125 anti-Xa units/kg IV bolus after thoracotomy, then 3 anti-Xa units/mL as priming fluid, then 7 anti-Xa units/kg/hr (started at bypass hookup and stopped 45 min before expected end of bypass), then 1250 anti-Xa units SUBQ twice daily or 750 anti-Xa units 3 times daily or 150—200 anti-Xa units/hr IV started 6 hr after procedure. Hemodialysis, every other day or less frequently: 3750 anti-Xa units IV bolus before 1st 2 hemodialysis, then 3000 anti-Xa units IV bolus (if plasma antifactor Xa level <300 units/L) or 2500 anti-Xa units IV (if plasma antifactory Xa levels 300—350) or 2000 anti-Xa units IV (if plasma antifactor Xa levels 350—400); Hemodialysis, every other day or less frequently, <55 kg: 2500 anti-Xa units IV bolus before 1st 2 hemodialysis, then 2000 anti-Xa units IV bolus (if plasma antifactory Xa level <300 units/L), or 1500 anti-Xa units IV (if plasma antifactory Xa levels 300—400); Hemodialysis, daily: 3750 anti-Xa units IV before 1st dialysis, then 2500 before 2nd dialysis; Hemodialysis, daily, <55 kg: 2500 anti-Xa units IV before 1st dialysis, then 2000 before 2nd dialysis; Hemofiltration, 55—90 kg: 2500 anti-Xa units IV bolus, then 600 anti-Xa units/hr for 4 hr, then 400 anti-Xa units/hr for 4 hr, then 200—600 anti-Xa units/hr to maintain plasma anti-Xa concentrations of 500—1000 units/L; Hemofiltration, <55 kg: 2000 anti-Xa units IV bolus, then 400 anti-Xa units/hr for 4 hr, then 150—400 anti-Xa units/hr to maintain anti-Xa concentrations of 500—1000 units/L.