Anticoagulant agents and special considerations at the end of life
| Anticoagulant . | Dose . | Considerations at end of life . |
|---|---|---|
| Unfractionated heparin | 8 units/kg/h IV infusion | Rarely indicated due to burdens of monitoring |
| Low-molecular-weight heparins | 1 mg/kg SQ Q12 h or 1.5 mg/kg SQ Q24 h | Some patients may prefer SQ injections to reduce pill burden or due to nausea |
| Dalteparin | 200 units/kg Q24 h or 100 units/kg Q12 h | Decreased or inconsistent nutritional intake can affect oral absorption |
| Fondaparinux | <50 kg: 5 mg SQ; 50-100 kg: 7.5 mg SQ; >100 kg: 10 mg SQ Q24 h | An option in HIT or for superficial vein thrombosis |
| Warfarin | Titrated to INR | INR monitoring may not meet patients' goals |
| Apixaban | 5 mg twice a day or 2.5 mg twice a day | Requires twice-daily administration |
| Rivaroxaban | 20 mg/d or 10 mg/d | Must be taken with food; contraindicated with liver disease |
| Edoxaban | 30 mg d | Consider drug-drug interactions |
| Dabigatran | 150 mg twice a day | Cannot be crushed |
| Anticoagulant . | Dose . | Considerations at end of life . |
|---|---|---|
| Unfractionated heparin | 8 units/kg/h IV infusion | Rarely indicated due to burdens of monitoring |
| Low-molecular-weight heparins | 1 mg/kg SQ Q12 h or 1.5 mg/kg SQ Q24 h | Some patients may prefer SQ injections to reduce pill burden or due to nausea |
| Dalteparin | 200 units/kg Q24 h or 100 units/kg Q12 h | Decreased or inconsistent nutritional intake can affect oral absorption |
| Fondaparinux | <50 kg: 5 mg SQ; 50-100 kg: 7.5 mg SQ; >100 kg: 10 mg SQ Q24 h | An option in HIT or for superficial vein thrombosis |
| Warfarin | Titrated to INR | INR monitoring may not meet patients' goals |
| Apixaban | 5 mg twice a day or 2.5 mg twice a day | Requires twice-daily administration |
| Rivaroxaban | 20 mg/d or 10 mg/d | Must be taken with food; contraindicated with liver disease |
| Edoxaban | 30 mg d | Consider drug-drug interactions |
| Dabigatran | 150 mg twice a day | Cannot be crushed |
HIT, heparin-induced thrombocytopenia; INR, international normalized ratio; IV, intravenous; SQ, subcutaneous.