Anticoagulation in special patient populations: are special dosing considerations required?

Optimal dosing of low-molecular-weight heparin (LMWH) therapy has not yet been established for patients with morbid obesity or renal insufficiency or for pregnant women. Monitoring of anti-Xa levels appears to be helpful in guiding LMWH dosing in all of these patient groups. Use of fondaparinux in these populations has yet to be defined. Cancer patients are at particular risk of venous thromboembolism and generally require escalated and/or prolonged anticoagulation with intense monitoring of therapy.