Classification of anticoagulant regimens by intensity
| Regimen . |
|---|
| Prophylactic* |
| Apixaban 2.5 mg, PO BID (with intent for VTE prophylaxis) |
| Bemiparin 3500 U, SC OD |
| Betrixaban 80 mg, PO OD |
| Betrixaban 160 mg, PO OD |
| Dabigatran 220 mg, PO OD |
| Dalteparin 5000 U, SC OD |
| Enoxaparin 30 mg (3000 U), SC OD (for GFR 15-30) |
| Enoxaparin 30 mg (3000 U), SC BID (for BMI ≥40 kg/m2) |
| Enoxaparin 40 mg (4000 U), SC OD |
| Enoxaparin 40 mg (4000 U), SC BID (for BMI ≥40 kg/m2) |
| Fondaparinux 2.5 mg, SC OD |
| Unfractionated heparin 5000 U, SC BID |
| Unfractionated heparin 5000 U, SC TID |
| Unfractionated heparin 7500 U, SC BID (for BMI ≥40 kg/m2) |
| Nadroparin 2850 U, SC q24h (post-op general surgery) |
| Nadroparin 5700 U, SC q24h (high-risk medical patients >70 kg) |
| Nadroparin 3800 U, SC q24h (high-risk medical patients ≤70 kg or post-op hip replacement surgery) |
| Rivaroxaban 10 mg, PO OD |
| Tinzaparin 3500 U, SC OD |
| Tinzaparin 4500 U, SC OD |
| Tinzaparin 75 U/kg, SC OD |
| Intermediate* |
| Enoxaparin 0.5 mg/kg (50 U/kg), SC BID (if CrCl >30 mL/min) |
| Enoxaparin 0.5 mg/kg (50 U/kg), SC OD (if CrCl <30 mL/min) |
| Enoxaparin 30 mg (3000 U), SC BID (for BMI <40 kg/m2) |
| Enoxaparin 40 mg (4000 U), SC BID (for CrCl >30 mL/min and BMI <40 kg/m2) |
| Enoxaparin 60 mg (6000 U), SC BID (for CrCl >30 mL/min and BMI >40 kg/m2) |
| Unfractionated heparin 7500 U, SC TID |
| Dalteparin 5000 U, SC BID |
| Therapeutic* |
| Acenocoumarol, PO (target INR 2.0-3.0 or greater) |
| Apixaban 5 mg, PO BID |
| Apixaban 10 mg, PO BID |
| Argatroban, IV to target aPTT therapeutic range as per institutional guidelines |
| Bemiparin 5000 U, SC OD (if weight ≤50 kg and CrCl >30 mL/min) |
| Bemiparin 7500 U, SC OD (if weight 50-70 kg and CrCl >30 mL/min) |
| Bemiparin 10000 U, SC OD (if weight 70-100 kg and CrCl >30 mL/min) |
| Bemiparin 115 U/kg, SC OD (if weight >100 kg and CrCl >30 mL/min) |
| Bivalirudin, IV to target aPTT therapeutic range as per institutional guidelines |
| Dabigatran 75 mg, PO BID (if CrCl 15-30 mL/min) |
| Dabigatran 110 mg, PO BID (AF: age ≥80 y, or >75 y and 1 or more risk factors for bleeding) |
| Dabigatran 150 mg, PO BID (if CrCl >30 mL/min) |
| Dalteparin 100 U/kg, SC BID |
| Dalteparin 150 U/kg, SC OD |
| Dalteparin 200 U/kg, SC OD |
| Edoxaban 30 mg, PO OD (≤60 kg, CrCl 15-50 mL/min) |
| Edoxaban 60 mg, PO OD (weight ≥60 kg and CrCl >50 mL/min) |
| Enoxaparin 0.8 mg/kg, SC BID (for BMI >40 and CrCl >30 mL/min) |
| Enoxaparin 1 mg/kg (100 U/kg), SC BID (for CrCl >30 mL/min) |
| Enoxaparin 1.5 mg/kg (150 U/kg), SC OD (for CrCl >30 mL/min) |
| Enoxaparin 1 mg/kg (100 U/kg), SC OD (for CrCl <30 mL/min) |
| Tinzaparin 175 U/kg, SC OD |
| Fluindione, PO (target INR 2.0-3.0 or greater) |
| Fondaparinux 5 mg, SC OD (if weight <50 and CrCl >50 mL/min |
| Fondaparinux 5 mg, SC OD (if weight 50-100 kg and CrCl 30-50 mL/min) |
| Fondaparinux 7.5 mg, SC OD (if weight 50-100 kg and CrCl >50 mL/min |
| Fondaparinux 7.5 mg, SC OD (if weight >100 kg and CrCl 30-50 mL/min) |
| Fondaparinux 10 mg, SC OD (if weight >100 kg and CrCl >30 mL/min) |
| Unfractionated heparin, IV to target aPTT therapeutic range as per institutional guidelines or anti-Xa activity 0.3-0.7 IU/mL |
| Unfractionated heparin 250 U/kg, SC q12h |
| Nadroparin 86 U/kg, SC q12h (for acute coronary syndrome) |
| Nadroparin 171 U/kg, q24h (for DVT treatment) |
| Phenprocoumon, PO (target INR 2.0-3.0 or greater) |
| Rivaroxaban 15 mg, PO BID |
| Rivaroxaban 15 mg, PO OD (for GFR 15-50 in AF patients) |
| Rivaroxaban 20 mg, PO OD |
| Warfarin, PO (target INR 2.0-3.0 or greater) |
| Regimen . |
|---|
| Prophylactic* |
| Apixaban 2.5 mg, PO BID (with intent for VTE prophylaxis) |
| Bemiparin 3500 U, SC OD |
| Betrixaban 80 mg, PO OD |
| Betrixaban 160 mg, PO OD |
| Dabigatran 220 mg, PO OD |
| Dalteparin 5000 U, SC OD |
| Enoxaparin 30 mg (3000 U), SC OD (for GFR 15-30) |
| Enoxaparin 30 mg (3000 U), SC BID (for BMI ≥40 kg/m2) |
| Enoxaparin 40 mg (4000 U), SC OD |
| Enoxaparin 40 mg (4000 U), SC BID (for BMI ≥40 kg/m2) |
| Fondaparinux 2.5 mg, SC OD |
| Unfractionated heparin 5000 U, SC BID |
| Unfractionated heparin 5000 U, SC TID |
| Unfractionated heparin 7500 U, SC BID (for BMI ≥40 kg/m2) |
| Nadroparin 2850 U, SC q24h (post-op general surgery) |
| Nadroparin 5700 U, SC q24h (high-risk medical patients >70 kg) |
| Nadroparin 3800 U, SC q24h (high-risk medical patients ≤70 kg or post-op hip replacement surgery) |
| Rivaroxaban 10 mg, PO OD |
| Tinzaparin 3500 U, SC OD |
| Tinzaparin 4500 U, SC OD |
| Tinzaparin 75 U/kg, SC OD |
| Intermediate* |
| Enoxaparin 0.5 mg/kg (50 U/kg), SC BID (if CrCl >30 mL/min) |
| Enoxaparin 0.5 mg/kg (50 U/kg), SC OD (if CrCl <30 mL/min) |
| Enoxaparin 30 mg (3000 U), SC BID (for BMI <40 kg/m2) |
| Enoxaparin 40 mg (4000 U), SC BID (for CrCl >30 mL/min and BMI <40 kg/m2) |
| Enoxaparin 60 mg (6000 U), SC BID (for CrCl >30 mL/min and BMI >40 kg/m2) |
| Unfractionated heparin 7500 U, SC TID |
| Dalteparin 5000 U, SC BID |
| Therapeutic* |
| Acenocoumarol, PO (target INR 2.0-3.0 or greater) |
| Apixaban 5 mg, PO BID |
| Apixaban 10 mg, PO BID |
| Argatroban, IV to target aPTT therapeutic range as per institutional guidelines |
| Bemiparin 5000 U, SC OD (if weight ≤50 kg and CrCl >30 mL/min) |
| Bemiparin 7500 U, SC OD (if weight 50-70 kg and CrCl >30 mL/min) |
| Bemiparin 10000 U, SC OD (if weight 70-100 kg and CrCl >30 mL/min) |
| Bemiparin 115 U/kg, SC OD (if weight >100 kg and CrCl >30 mL/min) |
| Bivalirudin, IV to target aPTT therapeutic range as per institutional guidelines |
| Dabigatran 75 mg, PO BID (if CrCl 15-30 mL/min) |
| Dabigatran 110 mg, PO BID (AF: age ≥80 y, or >75 y and 1 or more risk factors for bleeding) |
| Dabigatran 150 mg, PO BID (if CrCl >30 mL/min) |
| Dalteparin 100 U/kg, SC BID |
| Dalteparin 150 U/kg, SC OD |
| Dalteparin 200 U/kg, SC OD |
| Edoxaban 30 mg, PO OD (≤60 kg, CrCl 15-50 mL/min) |
| Edoxaban 60 mg, PO OD (weight ≥60 kg and CrCl >50 mL/min) |
| Enoxaparin 0.8 mg/kg, SC BID (for BMI >40 and CrCl >30 mL/min) |
| Enoxaparin 1 mg/kg (100 U/kg), SC BID (for CrCl >30 mL/min) |
| Enoxaparin 1.5 mg/kg (150 U/kg), SC OD (for CrCl >30 mL/min) |
| Enoxaparin 1 mg/kg (100 U/kg), SC OD (for CrCl <30 mL/min) |
| Tinzaparin 175 U/kg, SC OD |
| Fluindione, PO (target INR 2.0-3.0 or greater) |
| Fondaparinux 5 mg, SC OD (if weight <50 and CrCl >50 mL/min |
| Fondaparinux 5 mg, SC OD (if weight 50-100 kg and CrCl 30-50 mL/min) |
| Fondaparinux 7.5 mg, SC OD (if weight 50-100 kg and CrCl >50 mL/min |
| Fondaparinux 7.5 mg, SC OD (if weight >100 kg and CrCl 30-50 mL/min) |
| Fondaparinux 10 mg, SC OD (if weight >100 kg and CrCl >30 mL/min) |
| Unfractionated heparin, IV to target aPTT therapeutic range as per institutional guidelines or anti-Xa activity 0.3-0.7 IU/mL |
| Unfractionated heparin 250 U/kg, SC q12h |
| Nadroparin 86 U/kg, SC q12h (for acute coronary syndrome) |
| Nadroparin 171 U/kg, q24h (for DVT treatment) |
| Phenprocoumon, PO (target INR 2.0-3.0 or greater) |
| Rivaroxaban 15 mg, PO BID |
| Rivaroxaban 15 mg, PO OD (for GFR 15-50 in AF patients) |
| Rivaroxaban 20 mg, PO OD |
| Warfarin, PO (target INR 2.0-3.0 or greater) |
AF, atrial fibrillation; aPTT, activated partial thromboplastin time; BID, twice daily; BMI, body mass index; CrCl, creatinine clearance; GFR, glomerular filtration rate; INR, international normalized ratio; OD, once a day; PO, oral; post-op, postoperative; q12h, every 12 hours; q24h, every 24 hours; SC, subcutaneous; TID, 3 times a day.
Intensity of anticoagulation.