WAVe Study - Weight Adjusted Dalteparin for Patients Over 90 kg With Acute Cancer Associated Venous Thromboembolism

Inclusion Criteria:

1. Known pathologically-confirmed cancer (other than basal-cell or squamous-cell carcinoma of the skin),
2. Confirmed symptomatic or incidental deep vein thrombosis requiring treatment, or confirmed symptomatic or incidental pulmonary embolism of a segmental or larger pulmonary artery,
3. Weight \> 90 kg,
4. Age ≥18 years,
5. Hemoglobin ≥ 80 g/L,
6. Able and willing to comply with study procedures and follow-up examinations contained within the written consent form.

Exclusion Criteria:

1. Acute VTE managed with thrombectomy, insertion of an inferior vena cava filter or with the use of thrombolytic agents,
2. More than 72 hours pre-treatment with therapeutic dosage of other LMWH, direct oral anticoagulants or vitamin K antagonists prior to enrolment to manage the current VTE event (unless the participant has been treated with weight-adjusted doses of commercial dalteparin in consistency with the dosing regime outlined in the protocol up to Day 7 visit \[±2 days\]),
3. Contraindication to heparin therapy:

   1. history of heparin induced thrombocytopenia (HIT) as reported by patient,
   2. platelet count of less than 50 x 109/L,
   3. actively bleeding,
   4. reported history of severe uncontrolled hypertension,
   5. documented peptic ulcer within 6 weeks,
   6. reported history of severe hepatic failure,
   7. creatinine clearance of \< 30 ml/min as calculated by the Cockcroft-Gault formula,
   8. heparin allergy,
   9. Other contraindication to anticoagulation.
4. An Eastern Cooperative Oncology Group (ECOG) Performance Status of 3 or 4 at the time of study enrolment,
5. Life expectancy \< 1 month,
6. Women of childbearing age without proper contraceptive measures and women who are pregnant or breast feeding,
7. Participating in another interventional trial that may result in co-intervention or contamination (to be determined by sponsor),
8. Unable/unwilling to provide informed consent.