Mechanism of Action: Acts by enhancing the inhibition of Factor Xa and thrombin, reducing the ability of blood to clot.
Indications
Primary Use: Prevention of deep vein thrombosis (DVT), which can lead to pulmonary embolism in patients undergoing abdominal surgery, hip or knee replacement surgery, or those with reduced mobility during acute illness.
Other Uses: Treatment of existing DVT with or without pulmonary embolism, and prevention of complications in patients with unstable angina and non-Q-wave myocardial infarction.
Dosage
Adults: Dosage varies based on condition treated; for DVT prevention post-surgery, typically 40 mg once daily subcutaneously. For treatment, 1 mg/kg every 12 hours or 1.5 mg/kg once daily.
Elderly: No dosage adjustments are necessary unless renal function is impaired.
Children: Safety and efficacy have not been fully established for all indications.
Administration
Method: Subcutaneous injection.
Precautions: Rotate injection sites daily to prevent bruising. Do not inject intramuscularly.
Common: Bleeding, injection site reactions, mild pain or bruising.
Less Common: Anemia, thrombocytopenia.
Rare but Serious: Severe bleeding, heparin-induced thrombocytopenia, osteoporosis with long-term use.
Warnings
Contraindications: Active major bleeding, thrombocytopenia associated with a positive test for antiplatelet antibody in the presence of enoxaparin, hypersensitivity to enoxaparin or heparin.
Black Box Warning: Epidural or spinal hematomas may occur with the concurrent use of enoxaparin and spinal/epidural anesthesia or spinal puncture, which can result in long-term or permanent paralysis.
Precautions
General: Monitor for signs of neurological impairment, which may precede bleeding.
Health Conditions: Use with caution in conditions with increased risk of hemorrhage. Monitor platelet counts closely.
Interactions
Medications: Increased risk of bleeding with anticoagulants, antiplatelet agents, and nonsteroidal anti-inflammatory drugs (NSAIDs).
Food: No significant food interactions.
Monitoring Parameters
Hemoglobin and Hematocrit: Monitor for decreases indicating bleeding.
Platelet Count: Monitor regularly to detect heparin-induced thrombocytopenia.
Renal Function: Assess renal function periodically, especially in the elderly or those with renal impairment.
Use in Children
Guidelines: Dosage must be carefully adjusted according to body weight and indication.
Use in Pregnancy
FDA Category: B. No evidence of risk in human studies; however, should be used during pregnancy only if clearly needed.
Use in Elderly
Considerations: Increased risk of bleeding; dose adjustments may be needed based on renal function.
Use in Kidney Disease
Adjustments: Dose reduction required in patients with renal impairment to prevent accumulation and increased bleeding risk.
Use in Liver Disease
Caution: Use with caution; may require dose adjustments or increased monitoring for bleeding.
Patient Counselling Points
Medication Use: Ensure proper technique for subcutaneous administration and importance of adherence to dosing schedule.
Side Effects: Report any unusual bruising, bleeding, or signs of thrombocytopenia (such as a rash of purple spots).
Lifestyle: Avoid activities with a high risk of bleeding or injury.
Table of Brand Names, Manufacturer, and Prices in USD
Brand Name
Manufacturer
Strength/Dosage Form
Price (USD)
Lovenox
Sanofi
40 mg/0.4 mL Syringe
$100.00
Clexane
Sanofi
20 mg/0.2 mL Syringe
$50.00
15 FAQs with Answers
What is Enoxaparin used for? – Primarily for the prevention and treatment of DVT and pulmonary embolism.
Can Enoxaparin cause bleeding? – Yes, bleeding is the most common side effect.
How is Enoxaparin administered? – Via subcutaneous injection.
What should I avoid while taking Enoxaparin? – Avoid activities that increase the risk of bleeding.
Is Enoxaparin safe during pregnancy? – Classified as Category B, considered safe but use only if necessary.
Can Enoxaparin be used with other anticoagulants? – Caution is needed due to increased bleeding risk.
What are signs of overdose with Enoxaparin? – Overdose can increase the risk of serious bleeding.
Is Enoxaparin safe for children? – Dosages must be carefully adjusted, not fully established for all uses.
What are the rare but serious side effects of Enoxaparin? – Severe bleeding, spinal/epidural hematoma.
How should I store Enoxaparin? – Store in its original package at room temperature, away from light.
Can Enoxaparin affect platelet counts? – Yes, it can cause thrombocytopenia.
What monitoring is required with Enoxaparin? – Regular monitoring of platelet counts, hemoglobin, and renal function.
What precautions should I take with Enoxaparin? – Monitor for signs of bleeding and neurological changes.
Who should not take Enoxaparin? – Those with active major bleeding or severe hypersensitivity to its components.
How does Enoxaparin work to prevent blood clots? – It inhibits key factors involved in the blood clotting process.