8
Treatment
Table 3. Dosing Regimens for Prophylaxis/Treatment of
VTE in Patients with Cancer
Clinical Setting Drug Regimen
a
Pharmacologic (Anticoagulant) Prophylaxis
Hospitalized
medical patients
b
Unfractionated
heparin
5,000 U q8h
c
Dalteparin 5,000 U qd
Enoxaparin 40 mg qd
Fondaparinux
d
2.5 mg qd
Surgical patients
b
Unfractionated
heparin
5,000 U 2–4 h pre-op and q8h
c
thereaer
e
Dalteparin
2,500 U 2–4 h pre-op
e
and 5,000 U qd
thereaer,
f
OR 5,000 U 2–4 h pre-ope or
10–12 h pre-op and 5,000 U qd thereaer
f
Enoxaparin
40 mg 2–4 h pre-op
e
or 10–12 hr pre-op and
40 mg qd thereaer
f
Fondaparinux
d
2.5 mg qd beginning 6–8h post-op
Outpatients
b
Dalteparin
d,g
5,000 U qd
Enoxaparin
d,g
40 mg qd
Fondaparinux
d,h
2.5 mg qd
Apixaban
d
2.5 mg orally, twice daily
Rivaroxaban
d
10 mg orally, once daily
Treatment of established VTE
i
Initial Unfractionated
heparin (UFH)
j
80 U/kg IV bolus, then 18 U/kg/h IV and
adjust dose based on aPTT
k
Dalteparin
j,l,m
100 U/kg q12h
200 U/kg qd
