From Lexi-Comp:
Neonates (<>
Prophylactic use: 0.75 mg/kg q12hrs
Therapeutic use: 1.5 mg/kg q12hrs
Infants (> 2 mo):
Prophylactic use: 0.5 mg/kg q12hrs
Therapeutic use: 1 mg/kg q12hrs
Then, check Antifactor Xa level and adjust to set maintenance dose:
< 0.35 U/ml → Increase by 20% - Check dose 4 hr after next dose
0.35-0.49 U/ml → Increase by 10% - Check dose 4 hr after next dose
0.5 - 1.0 U/ml → No change - Check level next day, 1 week later and monthly
1.1 - 1.5 U/ml → Decrease by 20% - Check level before next dose
1.6 - 2.0 U/ml → Hold dose for 3 hrs and Decrease by 30% - Check level before next dose and 4 hr after
? 2.0 U/ml → Hold doses until level is 0.5 U/ml, Resume with decreased dose by 40% - Check every 12 hrs until level < 0.5 U/ml. Then, before next dose.
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