Table 4.
| Pharmacologic prophylaxis options | ||
| UFH | 5,000 Units every 8 h | |
| Dalteparina,b | 5,000 Units once daily subcutaneous | |
| Enoxaparinc | 40 mg once daily subcutaneous | |
| Fondaparinuxd | 2.5 mg once daily subcutaneous | |
| Apixabane | 2.5 mg orally twice daily | |
| Rivaroxaban | 10 mg orally once daily | |
| Treatment of established VTE management options | ||
| UFH | 80 Units/kg IV bolus followed by 18 Units/kg/h IV* | |
| Dalteparina,b,g | Initially, 200 Units/kg subcutaneous once daily for 30 days | |
| Followed by 150 Units/kg subcutaneous once daily | ||
| Enoxaparinc | 1 mg/kg every 12 hours; or | |
| 1.5 mg/kg once daily | ||
| Tinzaparin | 175 Units/kg once daily subcutaneous | |
| Fondaparinuxd | Weight-based dosing regimen | < 50 kg: 5 mg once daily subcutaneous |
| 50-100 kg: 7.5 mg once daily subcutaneous | ||
| > 100 kg: 10 mg once daily subcutaneous | ||
| Apixabane | Initially, 10 mg orally twice daily after that | |
| Followed by 5 mg orally twice daily after that | ||
| Rivaroxabanf | Initially, 15 mg orally every 12 h for 21 days | |
| Followed by 20 mg orally once daily after that | ||
| Edoxabanh | Weight-based dosing regimen | ≥ 60 mg orally once daily |
| ≤ 60 kg: 30 mg orally once dailyi | ||
aPTT, Activated Partial Thromboplastin; VTE, venous thromboembolism.
FDA approved LMWH for an extended therapy to prevent recurrent thrombosis in patients with cancer.
In renal impairment cancer patients with CrCl ≤ 30 mL/min, monitor anti-factor Xa levels and adjust the dose accordingly to achieve target range 0.5–1.5 international unit.
Mainly renally cleared; avoid in patients with CrCl ≤ 30 mL/min or adjust the dose according to anti-factor Xa levels.
In renal impairment patients with CrCl ≤ 30 mL/min, use is contraindicated by manufacture labeling.
In severe hepatic impairment, Child-Pugh Class C apixaban is not recommended.
Doses to be taken with food.
Maximum daily 18,000 units per day, therapy beyond 6 months not established.
In moderate to severe hepatic impairment (Child-Pugh Class B and C) edoxaban is not recommended.
If the patients' CrCl 30–50 mL/min, or the patient needs concomitant use of a P-glycoprotein inhibitor.
After which adjust the dose based on aPTT.