Enoxaparin

General

• Type: Low molecular weight heparin
• Dosage Forms: subcutaneous
• Common Trade Names: Lovenox

Adult Dosing

Therapeutic anticoagulation (e.g. treating DVT/PE, unstable angina)

• 1mg/kg SC q12h

Chemical Prophylaxis of VTE

• Lovenox 30mg SubQ q12 hrs (if Cr Clearance > 30)
  • Check Anti-Xa level every week EXACTLY 4 hours after 3rd dose of lovenox
    • prophylactic goal: 0.2-0.6
    • therapeutic goal: 0.6-1.2
• Recheck AntiXa level after each 3rd dose if dose is changed until you are at goal
• Recheck level every week (usually qMonday) for all patients
• If renal dysfunction order heparin 5000 Units SubQ q8 hrs (search “SURG DVT/VTE prophylaxis” order set)

Pediatric Dosing

Off-label

• DVT prophylaxis:
  • <2 months: 0.75 mg/kg SC q12hr
  • ≥2 months: 0.5 mg/kg SC q12h
• Therapeutic anticoagulation:
  • <2 months: 1.5 mg/kg SC q12hr
  • ≥2 months: 1 mg/kg SC q12hr

Special Populations

• Pregnancy Rating: B
• Lactation: Unknown risk
• Renal Dosing
  • Renal impairment (creatinine clearance <30)
    • Use 50% of usual dose or use UFH instead
• Hepatic Dosing: not established
• Obesity
  • Weight-based dosing safe up to 190kg (no data available thereafter)

Indications

• DVT
• PE
• NSTEMI
• STEMI

Contraindications

• Allergy to class/drug

Adverse Reactions

• Bleeding
• Pruritus
• Local skin reaction

Pharmacology

• Half-life: 4.5h
• Metabolism: hepatic
• Excretion: urine
• Mechanism of Action: inhibits factor Xa by increasing inhibition rate of clotting proteases that are activated by antithrombin III

Indications by Condition

The following table is automatically generated from disease/condition pages across WikEM.

	Indication	Dose	Context	Route	Population
Non-ST-elevation myocardial infarction#Enoxaparin Antithrombotic; preferred over UFH unless CABG within 24hr Adult	Non-ST-elevation myocardial infarction	1mg/kg BID	Antithrombotic; preferred over UFH unless CABG within 24hr	SC	Adult
Pulmonary embolism#Enoxaparin Anticoagulation (1st line, LMWH) Adult	Pulmonary embolism	1 mg/kg SC q12h	Anticoagulation (1st line, LMWH)	SC	Adult
ST-segment elevation myocardial infarction#Enoxaparin Anticoagulation (LMWH) Adult	ST-segment elevation myocardial infarction	30 mg IV bolus, then 1 mg/kg SC q12h (<75yo); 0.75 mg/kg SC q12h (≥75yo); 1 mg/kg SC daily (CrCl <30)	Anticoagulation (LMWH)	IV/SC	Adult
Unstable angina#Enoxaparin Antithrombotic, alternative to UFH Adult	Unstable angina	1mg/kg SC q12hr	Antithrombotic, alternative to UFH	SC	Adult

See Also

• Heparin (Unfractionated)
• Coagulopathy (Main)
• Anticoagulant reversal for life-threatening bleeds