Low molecular weight heparin for VTE prophylaxis
Low molecular weight heparin (LMWH) (eg enoxaparin, dalteparin) is preferred to unfractionated heparin (UFH) for venous thromboembolism (VTE) (ie deep vein thrombosis [DVT] or pulmonary embolism [PE]) prophylaxis. LMWH is safer, more effective and associated with a lower incidence of heparin-induced thrombocytopenia, and a slightly lower incidence of mortality Anderson, 2019.
For LMWH indications and duration for nonsurgical patients, see Examples of VTE prophylaxis for nonsurgical patients in hospital; for surgical patients, see VTE prophylaxis for surgical patients in hospital.
LMWH dosage regimens for VTE prophylaxis are:
1dalteparin (CrCl 30 mL/min or more) 5000 units subcutaneously, once daily1 dalteparin dalteparin dalteparin
OR
1enoxaparin enoxaparin enoxaparin enoxaparin
CrCl 30 mL/min or more: 40 mg subcutaneously, once daily
CrCl less than 30 mL/min: 20 mg subcutaneously, once daily.
If dalteparin is required for patients with a calculated creatinine clearance (CrCl) less than 30 mL/min, seek expert advice.
The optimal VTE prophylaxis in patients with obesity has not been fully determined, but there is no clear evidence that higher doses of LMWH are required in patients with obesity; for more information, see Parenteral anticoagulants for VTE prophylaxis in patients with obesity.