Patient Care


A dosage recommendation in the August 2012 article “What is the Optimal Therapy for Acute DVT” (p. 17) should have read: The 2012 American College of Chest Physicians (ACCP) guidelines on antithrombotic therapy for VTE recommends initial therapy with LMWH or fondaparinux (rather than IV or SC UFH). The guidelines suggest that LMWH once-daily dosing is favored over twice-daily dosing, based mainly on patient convenience, although this is a weak recommendation (2C) based on the overall quality of the data. The recommendation applies only if the daily dosing of the LMWH, including tinzaparin, dalteparin, and nadroparin, is equivalent to the twice-daily dosing (i.e. dalteparin may be dosed at 100 units/kg BID vs. 200 units/kg daily). Of importance, enoxaparin has not been studied at a once-daily dose (2 mg/kg), which is equivalent to the twice-daily dosing regimen (1 mg/kg twice daily). Additionally, one study suggests that once-daily dosing of enoxaparin 1.5 mg/kg might be inferior to 1 mg/kg twice daily dosing; therefore, caution must be exercised in applying this recommendation to the LMWH enoxaparin.3,27,28

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