Table 1.

Anticoagulant dosing and special considerations.

Drug	Dose	Special Considerations
UFH 1	80 unit/kg IV bolus, followed by an 18-unit/kg/hour infusion [6].
Enoxaparin	1 mg/kg subQ 2 BID 3 [12,13].
Dalteparin	200 IU/kg/day 4 subQ for one month, followed by 150 IU/kg/day subcutaneously for months 2 through 6 [14].	Maximum of 18,000 IU per day.
Fondaparinux	<50 kg: 5 mg subQ daily 50–100 mg: 7.5 mg subQ daily >100 kg: 10 mg subQ daily	Initiate warfarin within 72 h and give concomitantly for at least 5 days.
Edoxaban	60 mg po once daily; 30 mg once daily if body weight ≤60 kg	Not for use in patients with CrCl > 95 mL/min 5. Dose after 5 to 10 days of initial therapy with a parenteral anticoagulant.
Apixaban	10 mg po twice daily for 7 days followed by 5 mg twice daily [15].
Rivaroxaban	15 mg po twice daily × 3 weeks, then 20 mg once daily × at least 6 months [16].	Take with food to improve absorption [17,18,19]
Dabigatran	150 mg po BID [20].; 110 mg BID for patients ≥80 years	Dose after 5 to 10 days of initial therapy with a parenteral anticoagulant. Reduce dose to 110 mg BID for patients ≥80 years or ≥75 years with at least one bleeding risk factor.

¹ UFH: unfractionated heparin; ² subQ: subcutaneously; ³ BID: twice a day; ⁴ IU: international units; ⁵ CrCL: creatinine clearance.