Our approach to breakthrough CAT
| Anticoagulant during breakthrough VTE . | New regimen . |
|---|---|
| Warfarin | Full-dose weight-based LMWH (enoxaparin 1 mg/kg twice daily or dalteparin 200 U/kg daily) or fondaparinux weight-based dose |
| DOAC | |
| Low-dose LMWH (enoxaparin 30-40 mg daily or dalteparin 5000 U daily) | |
| Intermediate-dose LMWH (enoxaparin 40 mg twice daily, 0.5 mg/kg twice daily, or 1 mg/kg daily or dalteparin 5000 U twice daily) | |
| 75% full-dose LMWH (enoxaparin 1.5 mg/kg daily or dalteparin 150 U/kg daily) | |
| Prophylactic dose fondaparinux (2.5 mg daily) | Full-dose weight-based fondaparinux (5-10 mg daily) |
| Full-dose weight-based LMWH (enoxaparin 1 mg/kg twice daily or dalteparin 200 U/kg daily) | Dose-escalated LMWH (120%-125% full weight-based dose) |
| Full-dose weight-based fondaparinux (5-10 mg daily) | Dose-escalated fondaparinux (full weight-based dose plus 2.5 mg) |
| Dose-escalated LMWH (120%-125% full weight-based dose) or fondaparinux (full weight-based dose plus 2.5 mg) | Experimental approaches: consider addition of antiplatelet agent or second anticoagulant with distinct mechanism of action |
| Anticoagulant during breakthrough VTE . | New regimen . |
|---|---|
| Warfarin | Full-dose weight-based LMWH (enoxaparin 1 mg/kg twice daily or dalteparin 200 U/kg daily) or fondaparinux weight-based dose |
| DOAC | |
| Low-dose LMWH (enoxaparin 30-40 mg daily or dalteparin 5000 U daily) | |
| Intermediate-dose LMWH (enoxaparin 40 mg twice daily, 0.5 mg/kg twice daily, or 1 mg/kg daily or dalteparin 5000 U twice daily) | |
| 75% full-dose LMWH (enoxaparin 1.5 mg/kg daily or dalteparin 150 U/kg daily) | |
| Prophylactic dose fondaparinux (2.5 mg daily) | Full-dose weight-based fondaparinux (5-10 mg daily) |
| Full-dose weight-based LMWH (enoxaparin 1 mg/kg twice daily or dalteparin 200 U/kg daily) | Dose-escalated LMWH (120%-125% full weight-based dose) |
| Full-dose weight-based fondaparinux (5-10 mg daily) | Dose-escalated fondaparinux (full weight-based dose plus 2.5 mg) |
| Dose-escalated LMWH (120%-125% full weight-based dose) or fondaparinux (full weight-based dose plus 2.5 mg) | Experimental approaches: consider addition of antiplatelet agent or second anticoagulant with distinct mechanism of action |