What are the prophylactic and therapeutic doses of low‑molecular‑weight heparin (LMWH) such as enoxaparin and dalteparin? | Rounds What are the prophylactic and therapeutic doses of low‑molecular‑weight heparin (LMWH) such as enoxaparin and dalteparin? | Rounds
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What are the prophylactic and therapeutic doses of low‑molecular‑weight heparin (LMWH) such as enoxaparin and dalteparin?

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Enoxaparin and Dalteparin Dosing for VTE Prophylaxis and Treatment

Prophylactic and therapeutic dosing of low-molecular-weight heparins depends on indication and the specific LMWH product. Standard adult regimens for enoxaparin and dalteparin are listed below based on FDA prescribing information. [1][2]

Enoxaparin (Lovenox) Prophylaxis

Subcutaneous VTE prophylaxis dosing commonly includes the following adult regimens: [1]

  • 40 mg subcutaneously once daily. [1]
  • 30 mg subcutaneously every 12 hours. [1]
  • 30 mg subcutaneously once daily (prophylaxis after abdominal surgery). [1]

Enoxaparin (Lovenox) Treatment

Subcutaneous therapeutic dosing commonly includes the following adult regimens: [1]

  • 1 mg/kg subcutaneously every 12 hours. [1]
  • 1.5 mg/kg subcutaneously once daily. [1]

Dalteparin (Fragmin) Prophylaxis

Subcutaneous VTE prophylaxis dosing commonly includes the following adult regimens: [2]

  • 5,000 IU subcutaneously once daily for medical patients with severely restricted mobility during acute illness. [2]
  • Abdominal surgery prophylaxis dosing options: 2,500 IU once daily or 5,000 IU once daily. [2]
  • Abdominal surgery prophylaxis option: 2,500 IU once daily followed by 2,500 IU subcutaneously 12 hours later, then 5,000 IU once daily. [2]

Dalteparin (Fragmin) Treatment

Subcutaneous therapeutic dosing commonly includes the following adult regimen: [2]

  • Cancer-associated VTE: 200 IU/kg subcutaneously once daily for the first 30 days, followed by 150 IU/kg subcutaneously once daily for months 2 through 6. [2]

Practical Dosing Clarifications

Dose selection should be indication-specific because dosing schedules differ by surgery type, prophylaxis setting, and therapeutic indication. [1][2]

Dose Conversion Between Prophylactic and Therapeutic Regimens

Therapeutic LMWH dosing should not be used as a substitute for prophylaxis dosing because the recommended dosing schedules differ by regimen class and indication. [1][2]

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