how to dose low-molecular-weight heparin (Lovenox, etc) in very obese patients

There's still controversy about how to dose low-molecular-weight heparin (Lovenox, etc) in very obese patients.

Some prescribers worry that doses based on total body weight will be too high for patients over 150 kg. This leads them to cap the dose to try to prevent overdosing.

In fact, Fragmin (dalteparin) labeling recommends a maximum treatment dose...the other low-molecular-weight heparins do not.

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