Initial dosing for LMWH agents in pediatric patients with normal kidney function* | ||
Drug | Therapeutic anticoagulation (for treatment of thrombosis) | Prophylaxis (for prevention of thrombosis) |
Enoxaparin | Preterm neonates: 2 mg/kg/dose subQ every 12 hours Term neonates: 1.5 to 1.7 mg/kg/dose subQ every 12 hours Infants ≥2 months, children, and adolescents: 1 mg/kg/dose subQ every 12 hours¶ | Infants <2 months: 0.75 mg/kg/dose subQ every 12 hours Infants ≥2 months, children, and adolescents: 0.5 mg/kg/dose subQ every 12 hours |
Dalteparin | Neonates: Limited data available; use of an alternative agent is suggested Infants and children <2 years: 150 units/kg/dose SubQ every 12 hours Children 2 to <8 years: 125 units/kg/dose SubQ every 12 hours Children >8 years and adolescents: 100 units/kg/dose SubQ every 12 hours (maximum 18,000 units/dose) | Neonates: Limited data available; use of an alternative agent is suggested Infants and children <50 kg: 100 units/kg/dose SubQ daily (maximum 5000 units/dose) Children and adolescents ≥50 kg: 5000 units SubQ daily |
NadroparinΔ | Neonates: 150 to 180 units/kg/dose SubQ every 12 hours Infants, children, and adolescents: 86 units/kg/dose SubQ every 12 hours (maximum dose 17,100 units/day) | Infants and children <50 kg: Limited data available; use of an alternative agent is suggested Adolescents ≥50 kg: 3800 units SubQ once daily |
ReviparinΔ | Infants <5 kg: 150 units/kg/dose SubQ every 12 hours Infants and children ≥5 kg: 100 units/kg/dose SubQ every 12 hours | Infants <5 kg: 50 units/kg/dose SubQ every 12 hours Infants and children ≥5 kg: 30 units/kg/dose SubQ every 12 hours |
TinzaparinΔ | Infants 0 to 2 months: 275 units/kg/dose SubQ daily Infants 2 to 12 months: 250 units/kg/dose SubQ daily Children 1 to 5 years: 240 units/kg/dose SubQ daily Children 5 to 10 years: 200 units/kg/dose SubQ daily (maximum 18,000 units/dose) Children and adolescents 10 to 16 years: 175 units/kg/dose SubQ daily (maximum 18,000 units/dose) | Infants and children 1 month to 17 years: 50 units/kg/dose SubQ daily |
Dose titration (for therapeutic anticoagulation only)◊ | ||
Anti-factor Xa level | Dose titration | Time to repeat anti-factor Xa level |
<0.35 units/mL | Increase dose by 25% | 4 hours after next dose |
0.35 to 0.49 units/mL | Increase dose by 10% | 4 hours after next dose |
0.5 to 1 unit/mL | Keep same dose | Repeat the next day (4 hours after dose) If stable, can go to weekly monitoring |
1.1 to 1.5 units/mL | Decrease dose by 20% | Before next dose |
1.6 to 2 units/mL | Hold dose for 3 hours, then decrease dose by 30% | Before next dose, then 4 hours after next dose |
>2 units/mL | Hold all doses until anti-factor Xa is 0.5 units/mL, then decrease dose by 40% | Before next dose and every 12 hours until anti-factor Xa is <0.5 units/mL |