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Enoxaparin

Medical and Pharmacy Editor:

Brand Name: Lovenox

Generic Name: Enoxaparin

Drug Class: Anticoagulants, Cardiovascular; Anticoagulants, Hematologic

What Is Enoxaparin and How Does It Work?

Enoxaparin is prescription medication used for as prophylaxis treatment of deep vein thrombosis (DVT), which may lead to pulmonary embolism (PE) in patients undergoing abdominal surgery, hip replacement surgery (during and following hospitalization), knee replacement surgery and in medical patient who are at risk for thromboembolic complications due to severe restricted mobility during acute illness.

Enoxaparin is available under the following different brand names: Lovenox.

Dosage of Enoxaparin:

Multidose vial

  • 100 mg/ml (3 ml/vial)

Prefilled syringe

  • 30 mg/0.3 ml
  • 40 mg/0.4 ml
  • 60 mg/0.6 ml
  • 80 mg/0.8 ml
  • 100 mg/ml
  • 120 mg/0.8 ml
  • 150 mg/ml

Adults

Abdominal surgery

  • 40 mg subcutaneously each day; initiate 2 hours preoperatively

Knee or hip replacement surgery

  • 30 mg subcutaneously every 12 hours; initiate therapy 12-24 hours postoperatively and continued for 10 days or up to 35 days postoperatively or until risk of deep vein thrombosis has been significantly reduced or patient is on anticoagulant therapy
  • For hip replacement surgery, may consider administering 40 mg subcutaneously each day, initiated 9-15 hours preoperatively and continued for 10 days or up to 35 days postoperatively or until risk of deep vein thrombosis has been significantly reduced or patient is on anticoagulant therapy

Medical patients with restricted mobility

  • 40 mg subcutaneously each day; continue until risk of deep vein thrombosis has been significantly (6-11 days) reduced or patient is on anticoagulant therapy

Dosing considerations

  • Abdominal surgery: Duration of administration is 7-10 days; up to 12 days has been administered in clinical trials or until risk of deep vein thrombosis has diminished
  • Knee or hip replacement surgery: Duration of administration is 7-10 days; up to 14 days has been administered in clinical trials or until risk of deep vein thrombosis has diminished Medical patients with restricted mobility: Duration of administration is 6-11 days; up to 14 days has been administered in clinical trials

Pediatric (off-label)

  • Infants under 2 months: 0.75 mg/kg subcutaneously every 12 hours
  • Infants 2 months or older: 0.5 mg/kg subcutaneously every 12 hours

Deep Vein Thrombosis (Treatment)

Adults

Inpatient treatment

  • Acute deep vein thrombosis with or without PE, when administered in conjunction with warfarin sodium
  • 1 mg/kg subcutaneously every 12 hours, or 1.5 mg/kg subcutaneously each day (administer at same time each day)

Outpatient treatment

  • Acute deep vein thrombosis without PE, when administered in conjunction with warfarin sodium
  • 1 mg/kg subcutaneously every 12 hours

Dosing considerations

  • In inpatient and outpatient treatments, initiate warfarin therapy within 72 hours of starting enoxaparin
  • Continue enoxaparin for a minimum of 5 days and until a therapeutic oral anticoagulant effect has been achieved (INR 2.0-3.0)
  • Average duration of administration is 7 days; up to 17 days has been administered in clinical trials

Pediatric

  • Infants under 2 months: 1.5 mg/kg subcutaneously every 12 hours
  • Infants 2 months or older: 1 mg/kg subcutaneously every 12 hours
    Dose Titration for Pediatric Dosing Based on Anti-Factor Xa Concentrations
  • Under 0.35 units/mL: Increase dose by 25%; administer next dose at scheduled time; repeat anti-factor Xa level 4 hours after next dose
  • 0.35-0.46 units/mL: Increase dose by 10%; administer next dose at scheduled time; repeat anti-factor Xa level 4 hours after next dose
  • 0.5 - 1 units/mL: Dose adjustment not necessary; administer next dose at scheduled time; repeat anti-factor Xa level every other day
  • 1.1-1.5 units/mL: Decrease dose by 20%; administer next dose at scheduled time; repeat anti-factor Xa level 4 hours after next dose
  • 1.6-2 units/mL: Decrease dose by 30%; delay next dose 3 hours; repeat anti-factor Xa level 4 hours after next dose
  • Greater than 2 units/mL: Decrease dose by 40%; delay next dose until anti-factor Xa under 0.5 units/mL; repeat anti-factor Xa level before next dose and every 12 hours until anti-factor Xa under 0.5 units/mL
  • Dosing considerations
    • Multi-dose vial contains benzyl alcohol, which is associated with gasping syndrome in premature infants
  • Unstable Angina and Non-Q-Wave Myocardial Infarction
    • Prophylaxis of ischemic complications of unstable angina and non-Q-wave myocardial infarction, when concurrently administered with aspirin 1 mg/kg subcutaneously every 12 hours
    • Regimen includes aspirin (100-325 mg/day orally)
  • Dosing considerations
    • Administer for at least 2 days and then continue until clinical stabilization
    • Usual duration of treatment is 2-8 days; up to 12.5 days has been administered in clinical trials
  • Acute Segment Elevation Myocardial Infarction (STEMI)
    • Reduce the rate of the combined endpoint of recurrent myocardial infarction or death in patients with acute ST-segment elevation myocardial infarction (STEMI) receiving thrombolysis and being managed medically or with percutaneous coronary intervention (PCI)
    • All patients should receive aspirin as soon as they are identified as having STEMI and should be maintained with 75-325 mg orally each day unless contraindicated
      • Younger than 75 years old
        • Loading dose: 30 mg intravenous bolus once plus 1 mg/kg subcutaneously once; not to exceed 100 mg cumulative loading dose
        • Maintenance: 1 mg/kg subcutaneously every 12 hours
      • Older than 75 years old
        • No intravenous bolus
        • 0.75 mg/kg subcutaneous 12 hour
        • Not to exceed 75 mg/dose for first 2 doses only, followed by 0.75 mg/kg for remaining doses
      • With percutaneous coronary intervention (PCI)
        • If last enoxaparin was given less than 8 hours before balloon inflation, no additional dosing is needed
        • If last enoxaparin was given 8-12 hour before balloon inflation, an intravenous bolus of 0.3 mg/kg should be administered
        • If percutaneous coronary intervention (PCI) occurs more than 12 hours after last subcutaneous dose; use established anticoagulation therapy (full-dose unfractionated heparin or low-molecular-weight heparin [LMWH])
        • Patient that has not received prior anticoagulant therapy: 0.5-0.75 mg/kg bolus dose
      • Dosing considerations
        • Administered concurrently with aspirin
        • In conjunction with thrombolytic: Administer enoxaparin between 15 minutes before and 30 minutes after initiating fibrinolytic therapy; optimal treatment duration of enoxaparin is 8 days or until hospital discharge (whichever comes first)
      • Dosing Modifications
      • Renal impairment
        • Severe (Creatinine Clearance under 30 mL/min): Dosage reductions required
        • Prophylaxis in abdominal surgery: 30 mg subcutaneously each day
        • Prophylaxis in hip or knee replacement surgery: 30 mg subcutaneously each day
        • Prophylaxis in medical patients with restricted mobility: 30 mg subcutaneously each day
        • Deep vein thrombosis treatment (inpatient or outpatient) coadministered with warfarin: 1 mg/kg subcutaneously each day
        • Non-Q-wave myocardial infarction: 1 mg/kg subcutaneously each day
        • Treatment of acute segment elevation myocardial infarction (STEMI) (under 75 years): 30 mg intravenously single bolus plus 1 mg/kg subcutaneously, THEN 1 mg/kg subcutaneously each day
        • Treatment of acute segment elevation myocardial infarction (STEMI) (over 75 years): No initial bolus; maintenance of 1 mg/kg subcutaneously each day
      • Administration
        • Low body weight (below 45 kg for women or below 57 kg for men): Increased exposure has been observed with prophylactic (non-weight adjusted) dosage; carefully monitor for sign/symptoms of bleeding
        • Administer deep subcutaneously alternating right and left anterior and posterior abdominal walls into skin fold held between thumb and forefinger
        • Use of tuberculin syringe (or equivalent) is recommended to assure appropriate measurement of dose
        • For intravenous administration, may administer in intravenous line with 0.9% NaCl or D5W
      • Geriatric
        • Increased risk of bleeding with doses of 1.5 mg/kg/day or 1 mg/kg every 12 hours
          • Dosing considerations
        • Risk of serious adverse reactions increases in the elderly
        • Body weight below 45 kg may require dose adjustment
Medically Reviewed by a Doctor on 6/8/2017



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