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Table 3 Permissible LMWH dose alterations

From: A feasibility study to inform the design of a randomized controlled trial to identify the most clinically and cost effective Anticoagulation Length with low molecular weight heparin In the treatment of Cancer Associated Thrombosis (ALICAT): study protocol for a mixed-methods study

Reason for increasing dose of LMWH:

Recurrence of symptomatic VTE despite administration of weight adjusted dose as per SPC. Some clinicians may use measurements of anti-Xa levels to guide LMWH dosing in this situation.

Reason for decreasing dose:

Sometimes patients may experience minor bleeding which will resolve on decreasing the dose of LMWH. This is a clinical decision of the supervising clinician that will be made based on balancing the perceived risks of recurrent VTE should LMWH be stopped or major bleeding should LMWH be continued.

Dose for obese patients:

Follow the SPC or local clinical practice.

Dose for renal impairment:

Follow the SPC. Patients with renal impairment should have dose adjustment depending on creatinine clearance/anti factor Xa levels according to local policy.

  1. LMWH, Low molecular weight heparin; SPC, summary of product characteristics; VTE, venous thromboembolism.
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