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Use of heparins during pregnancy

Use of heparins during pregnancy
Heparin Dose level Dose
LMW heparin Prophylactic* Enoxaparin 40 mg SC once daily
Dalteparin 5000 units SC once daily
Intermediate Enoxaparin 40 mg SC once daily, increase as pregnancy progresses to 1 mg/kg once daily
Dalteparin 5000 units SC once daily, increase as pregnancy progresses to 100 units/kg once daily
Therapeutic Enoxaparin 1 mg/kg SC every 12 hours
Dalteparin 100 units/kg SC every 12 hours
Unfractionated heparin Prophylactic 5000 units SC every 12 hours
Intermediate First trimester: 5000 to 7500 units SC every 12 hours
Second trimester: 7500 to 10,000 units SC every 12 hours
Third trimester: 10,000 units SC every 12 hours
Therapeutic Can be given as a continuous IV infusion or an SC dose every 12 hours. Titrated to keep the aPTT in the therapeutic range.
Doses apply to pregnant women receiving heparin for venous thromboembolism prophylaxis. Therapeutic-dose level refers to doses used both for prophylaxis in individuals at especially high risk and for treatment of venous thromboembolism. This dosing table should not be used in women with prosthetic heart valves. Refer to the UpToDate topic on anticoagulant use in pregnancy for details of administration and monitoring. Refer to UpToDate topics on specific pregnant patient populations for other dosing recommendations (eg, prosthetic heart valve, atrial fibrillation, treatment of deep vein thrombosis or pulmonary embolism).
LMW: low molecular weight; SC: subcutaneously; IV: intravenous; aPTT: activated partial thromboplastin time; ACCP: American College of Clinical Pharmacy; ACOG: American College of Obstetricians and Gynecologists. 
* Prophylactic dosing may require modifications for extremes of body weight.
¶ Our "intermediate" dose level differs from that used in society guidelines (eg, ACCP, ACOG). Some clinicians prefer to use a different "intermediate" dose level such as enoxaparin 40 mg SC every 12 hours; however, this entails a significant increase in the number of injections over the course of the pregnancy.
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