Dosing

Enoxaparin (Lovenox)—comes in prefilled syringes 30mg, 40mg, 60mg, 80mg, 100mg, 120mg, 150mg

• Therapeutic enoxaparin = 1.5mg/kg/day or 1mg/kg/bid
• Prophylactic enoxaparin = 40mg/day
• Dose adjustment required/precaution advised for CrCl < 30mL/min
• Dose adjustment required/precaution advised for obese patients with a BMI ≥ 40 kg/m2. Consider enoxaparin 0.75 mg/kg bid (therapeutic dosing) and enoxaparin 0.5 mg/kg (prophylactic dosing). Consider anti-Xa monitoring.
• Round all enoxaparin doses to the nearest injection syringe availability. Do not have patients displace or “squirt out” some of the medication prior to administration

Dalteparin (Fragmin)—comes in prefilled syringes 2500units, 5000units, 7500units, 10,000units, 12,500units, 15,000units, 18,000units, 25,000units

• Therapeutic dalteparin = 200units/kg/day
• Prophylactic dalteparin = 2500-5000units/day
• Dose adjustment required/precaution advised for CrCl < 30mL/min
• 5000 units/day may be reasonable for patients undergoing dialysis based on a study from 2010

Reference

Schmid P, Brodmann D, Fischer AG, Wuillemin WA. Prospective observational cohort study of bioaccumulation of dalteparin at a prophylactic dose in patients with peritoneal dialysis. J Thromb Haemost. 2010 Apr;8(4):850-2. Epub 2010 Jan 17.

Nutescu EA, Spinler SA, Wittkowsky A, Dager WE. Low-molecular-weight heparins in renal impairment and obesity: available evidence and clinical practice recommendations across medical and surgical settings. Ann Pharmacother. 2009;43(6):1064-83.

Lalama JT, Feeney ME, Vandiver JW, et al. Assessing an enoxaparin dosing in morbidly obese patients. J Thromb Thrombolysis. 2015; 39:516-521