Dosage Forms. Prefilled Syringes: 30 mg/0.3 mL, 40 mg/0.4 mL, 60 mg/0.6 mL, 80 mg/0.8 mL, 100 mg/1 mL, 120 mg/0.8 mL, 150 mg/1 mL; Multiple-Dose Vial: 300 mg/3 mL
Common FDA Label Indication, Dosing, and Titration.
1. Deep vein thrombosis prophylaxis, abdominal surgery: 40 mg sq once 2 h prior to surgery, then daily × 7-10 d
2. Deep vein thrombosis prophylaxis, hip or knee replacement surgery: 30 mg sq q12h starting 12-24 h postoperatively × 7-14 d
3. Deep vein thrombosis prophylaxis, acute medical illness: 40 mg sq daily × 6-11 d
4. Deep vein thrombosis treatment: 1 mg/kg sq q12h; initiate warfarin therapy as soon as possible and continue enoxaparin for at least 5 d and until target INR is reached
5. Acute ST segment elevation myocardial infarction: Age <75 y, 30 mg IV together with 1 mg/kg sq once, then 1 mg/kg sq q12h (max of 100 mg for the first 2 doses only); age 75 y and older, 0.75 mg/kg sq q12h (no initial bolus)
6. Unstable angina and non-Q-wave myocardial infarction: 1 mg/kg sq q12h × 2-8 d with aspirin 100-325 mg po daily
Off-Label Uses. None
MOA. Enoxaparin is a low-molecular-weight heparin which has anti-factor Xa and IIa properties.
Drug Characteristics: Enoxaparin
Medication Safety Issues: Enoxaparin
Drug Interactions: Enoxaparin
Adverse Reactions: Enoxaparin
Efficacy Monitoring Parameters. Prevention or resolution of thrombosis, depending on indication.
Toxicity Monitoring Parameters. Signs and symptoms of bleeding, CBC, LFTs. Patients with renal failure, obese patients, pregnant patients, and others at risk of bleeding complications should be monitored using anti-factor Xa testing.
Key Patient Counseling Points. If self-administered (outside healthcare facility), instruct patient on appropriate administration technique. Monitor for signs of thrombosis and bleeding complications.
Clinical Pearls. Unlike unfractionated heparin, low-molecular-weight heparins cannot be monitored using standard activated partial thromboplastin time (aPTT). Anti-factor Xa levels are needed for monitoring. Epidural or spinal hematomas may occur in patients who receive low-molecular-weight heparins for neuraxial anesthesia, who undergo spinal puncture, or who have an indwelling epidural catheter.