Please check out our article which provides a general overview of anticoagulation before reading this article!
Thromboprophylaxis based on patient group
Patient group | Recommended therapy | Duration of treatment |
Major trauma | LMWH | Until discharge |
Hip OR knee replacement | DOAC (to ASA) | 2 – 5 weeks |
General surgery | LMWH | Until discharge |
Major cancer surgery | LMWH | Up to 30 days after discharge |
Cancer medical illness | LMWH | Until discharge |
Acute medical illness | LMWH | Until discharge |
High bleeding risk | Bilateral, calf-length TED stockings | Until bleeding risk allows use of anticoagulant |
Dosing enoxaparin based on weight
- Weight < 40 kg OR CrCl < 30 mL/min
- Enoxaparin 30 mg subcutaneous every night at bedtime
- Weight 40 – 100 kg
- Enoxaparin 40 mg subcutaneous every night at bedtime
- Weight > 100 kg
- Enoxaparin 40 mg subcutaneous BID
- Weight > 125 kg
- Enoxaparin 0.4 mg/kg subcutaneous BID
Thromboprophylactic doses of DOACs
- Apixaban (BID dosing) (renal + liver)
- 2.5 mg PO BID
- Dabigatran (BID dosing) (renally cleared)
- Avoid with CrCl < 30
- CrCl 15 to 30 = 75 mg BID
- CrCl 30 to 50 = between 75 – 110 mg BID
- CrCl >50 = 110 mg BID
- Rivaroxaban (once daily dosing) (renal + liver)
- 10 mg PO once daily