Table 3.

Recommended anticoagulant regimens for venous thromboembolism prophylaxis and treatment in patients with cancer.

Management	Drug	Regimen
Prophylaxis
	Unfractionated heparin	5,000 IU SQ, every 8 h
	Dalteparin	5,000 IU SQ, daily
	Enoxaparin	40 mg SQ, daily
	Tinzaparin	2.5 mg SQ, daily
	Fondaparinux	75 IU/kg SQ, daily
Initial treatment
	Unfractionated heparin	80 IU/kg IV bolus, then 18 IU/kg/h IV
	Dalteparin*	100 IU/kg SQ every 12 h or 200 IU/kg SQ every 24 h
	Enoxaparin*	1 mg/kg SQ every 12 h or 1.5 mg/kg SQ daily
	Tinzaparin	175 IU/kg SQ daily
	Fondaparinux*	<50 kg: 2.5–5 mg SQ, daily
		50–100 kg: 5–7.5 mg SQ, daily
		>100 kg: 7.5–10 mg SQ, daily
Long-term treatment
	Dalteparin	200 IU/kg SQ daily × 1 month then 150 IU/kg SQ daily
	Warfarin	5–10 mg PO daily, adjust dose to INR 2.0–3.0

*Avoid in patients with creatinine clearance <35 ml/min or adjust dose based on anti-factor Xa level.

Modified from Verso et al. (71).