Ctrl

K

Enoxaparin

Intravenous
Subcutaneous
Class
Anticoagulants
Subclass
Low molecular weight heparins
Substance name
Enoxaparin sodium
Brand names
Lovenox®
Common formulations
Solution for injection
Dosage and administration
Adults patients
STEMI
•
Loading: 30 mg IV bolus plus a 1 mg/kg SC dose
•
Subsequently: 1 mg/kg SC q12h (maximum 100 mg for the first two doses) for 8 days or until hospital discharge
Administered in combination with aspirin. When used in conjunction with a thrombolytic, administer enoxaparin between 15 minutes before and 30 minutes after the start of fibrinolytic therapy. For patients managed with PCI, administer an intravenously bolus of 0.3 mg/kg of enoxaparin if the last subcutaneously dose was given > 8 hours before balloon inflation. Do not administer an initial intravenously bolus in patients aged ≥ 75 years. Initiate at 0.75 mg/kg subcutaneously BID (maximum 75 mg for the first two doses), followed by 0.75 mg/kg dosing for the remaining doses.
Non-ST-elevation acute coronary syndrome • No prior anticoagulant therapy, during PCI • Off-label
•
0.5-0.75 mg/kg IV bolus
Indications for use
Labeled indications
Adults
•
Adjunctive treatment for STEMI
Off-label indications
Adults
•
Adjunctive treatment for non-ST-elevation acute coronary syndrome (no prior anticoagulant therapy), in patients undergoing PCI
Safety risks
Boxed warnings
Epidural hematoma, spinal hematoma
•
Use extreme caution in patients receiving neuraxial anesthesia or undergoing spinal puncture, especially if risk factors for hemorrhage are present, such as an indwelling epidural catheter, concomitant drugs affecting hemostasis (such as NSAIDs, platelet inhibitors, anticoagulants), a history of traumatic or repeated epidural or spinal punctures, or a history of spinal deformity or spinal surgery. Monitor patients frequently for signs and symptoms of neurological impairment.
Contraindications
Hypersensitivity to enoxaparin or its components
Active major bleeding
History of heparin-induced thrombocytopenia
•
Do not use enoxaparin in patients with a history of immune-mediated heparin-induced thrombocytopenia within the past 100 days or in the presence of circulating antibodies.
Warnings and precautions
Decreased platelet count
•
Maintain a high level of suspicion, as thrombocytopenia can occur with the use of enoxaparin.
Gasping syndrome
•
Use caution in infants, as enoxaparin sodium vials contain benzyl alcohol preservative.
Hemorrhage
•
Use extreme caution in patients at high risk of hemorrhage, including bacterial endocarditis, congenital or acquired bleeding disorders, active ulcerative or angiodysplastic gastrointestinal disease, hemorrhagic stroke, recent brain, spinal, or ophthalmologic surgery, or concomitant use of platelet inhibitors.
•
Use caution in patients with bleeding disorder, uncontrolled hypertension, or a history of recent gastrointestinal ulceration, diabetic retinopathy, renal dysfunction, or hemorrhage.
•
Use caution in patients undergoing PCI. If manual compression is used at the puncture site after PCI, remove the sheath 6 hours after the last enoxaparin dose. Administer the next scheduled dose no sooner than 6-8 hours after sheath removal.
Heparin-induced thrombocytopenia
•
Maintain a high level of suspicion, as enoxaparin may cause heparin-induced thrombocytopenia with or without thrombosis.
Prosthetic valve thrombosis
•
Use caution for thromboprophylaxis in pregnant women with mechanical prosthetic heart valves, as the risk of thromboembolism is higher in this population. Obtain frequent monitoring of peak and trough anti-factor Xa levels and adjust the dosage.
Specific populations
Renal impairment
CrCl ≥ 30 mL/min
•
Use acceptable. No dose adjustment required. Monitor for bleeding.
CrCl < 30 mL/min
•
Reduce to 30 mg SC once daily for thromboprophylaxis, 30 mg IV bolus plus 1 mg/kg SC dose followed by 1 mg/kg SC once daily for ST-elevation myocardial infarction in patients aged < 75 years, and 1 mg/kg SC for other indications.
Renal replacement therapy
Any modality
•
Avoid use. Monitor anti-factor Xa levels. Monitor for bleeding.
Hepatic impairment
Any severity
•
No guidance available.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: C
•
Use only if clearly needed. Use caution for thromboprophylaxis in pregnant women with mechanical prosthetic heart valves, as the risk of thromboembolism is higher in this population, with reported cases of prosthetic valve thrombosis in patients receiving enoxaparin. Obtain frequent monitoring of peak and trough anti-factor Xa levels and adjust the dosage.
Breastfeeding
Use only if benefits outweigh potential risks.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
Unlikely to cause adverse effects in breastfed infants.
Adverse reactions
Very common > 10%
•
Anemia, bleeding
Common 1-10%
•
↓ platelet count, ↑ serum AST, ↑ serum ALT, peripheral edema, confusion, diarrhea, diarrhea, dyspnea, fever, hematuria, nausea
Uncommon < 1%
•
Atrial fibrillation, pulmonary edema, heart failure, intracranial hemorrhage, pneumonia
Unknown frequency
•
Ocular hemorrhage, itching, urticaria, vesiculobullous rash, skin necrosis, purpura, ↑ serum potassium, ↑ serum cholesterol, ↑ serum triglycerides, headache, hair loss, ↑ blood eosinophil count, ↑ platelet count, gastrointestinal bleeding, spinal hematoma, retroperitoneal hemorrhage, epidural hematoma, anaphylaxis, cholestasis, thrombosis, osteoporosis
Interactions
Drug(s)
Check Interactions
Reset

What did you think about this content?

Create free account

Sign up for free to access the full drug resource