Enoxaparin
LOVENOX
What it isLow-molecular-weight heparin that activates antithrombin to inhibit factor Xa; VTE and acute coronary syndromes.
Why this oneIt is the US default LMWH, with unusually broad use across VTE, pregnancy, and acute coronary syndromes.
What limits itRenal impairment increases bleeding risk. Protamine reverses it only partly; neuraxial procedures risk spinal hematoma.
FDA-approved for
- DVT prophylaxis and treatment (1993)
- acute coronary syndromes
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| VTE prophylaxis, abdominal surgery | adult | 40 mg SC QD (first dose 2 h pre-op) | 40 mg SC QD | 40 mg SC QD |
| VTE prophylaxis, hip/knee replacement | adult | 30 mg SC q12h (start 12-24 h post-op) | 30 mg SC q12h; hip: 40 mg SC QD up to 3 wk | — |
| VTE prophylaxis, acute medical illness | adult | 40 mg SC QD | 40 mg SC QD | 40 mg SC QD |
| DVT treatment, outpatient (no PE) | adult | 1 mg/kg SC q12h | 1 mg/kg SC q12h | — |
| DVT treatment, inpatient (with/without PE) | adult | 1 mg/kg SC q12h or 1.5 mg/kg SC QD | 1 mg/kg SC q12h or 1.5 mg/kg SC QD | — |
| Unstable angina / NSTEMI | adult | 1 mg/kg SC q12h + aspirin | 1 mg/kg SC q12h | — |
| Acute STEMI | <75 yr | 30 mg IV bolus + 1 mg/kg SC, then 1 mg/kg SC q12h | 1 mg/kg SC q12h | 100 mg for first two doses only |
| Acute STEMI | >=75 yr | reduced dose, no IV bolus (see 2.4) | reduced dose q12h | — |
Renal CrCl <30 mL/min: reduce dose (prophylaxis 30 mg SC QD; treatment 1 mg/kg SC QD).
Hepatic Undefined
STEMI: max 100 mg for the first two doses only; reduce dose in patients >=75 yr.
Instructions
- Subcutaneous injection; do not mix with other injections/solutions
- Evaluate for bleeding disorder before starting
- STEMI: give aspirin; time relative to fibrinolytic (15 min before to 30 min after)
- Not interchangeable unit-for-unit with heparin or other LMWH
Contraindications
- Active major bleeding
- History of immune-mediated HIT within past 100 days or circulating antibodies
- Known hypersensitivity to heparin or pork products
Cautions
- Increased risk of hemorrhage
- Thrombocytopenia / heparin-induced thrombocytopenia
- Spinal/epidural hematoma with neuraxial procedures
- Not interchangeable with other LMWHs or heparin
Adverse reactions
- Bleeding
- Anemia
- Thrombocytopenia
- Elevated aminotransferases
- Injection-site pain / ecchymosis
- Fever, edema
Pregnancy Human cohort data (693 live births) suggest no increased risk of major malformations.
Lactation Undefined
⚠ BOXED WARNING
- Spinal or epidural hematoma with neuraxial anesthesia
Cost, est. cash$4–$300/month
Generic entry2010
Classes and tags
Clinical profile
Legacy pregnancy categoryB
Defining liabilityMajor bleeding, accumulation in renal impairment and heparin-induced thrombocytopenia.
Mechanism of action: Enoxaparin ballicule
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