Skip to content

Enoxaparin

    DEA Class; Rx

    Common Brand Names; Lovenox

    • Anticoagulants, Cardiovascular; 
    • Anticoagulants, Hematologic

    Low molecular weight heparin (LMWH)
    Used for prophylaxis and management of systemic thromboembolism
    More predictable anticoagulant response than unfractionated heparin

    Indicated for the treatment of venous thromboembolism (VTE) including acute deep venous thrombosis (DVT) or pulmonary embolism (PE).

    For thrombosis prophylaxis.
    For the treatment of cerebral thromboembolism (e.g., cerebral venous sinus thrombosis).
    For coronary artery thrombosis prophylaxis and the prevention of ischemic complications in patients with acute coronary syndrome (ACS), including patients undergoing percutaneous coronary intervention (PCI).
    For the prevention of pregnancy loss and/or thrombosis in patients with antiphospholipid antibody syndrome (APLA).
    For periprocedural anticoagulation (bridge therapy) in patients with atrial fibrillation, mechanical heart valve, or venous thrombosis who require an interruption in oral anticoagulant therapy.
    For the management of multisystem inflammatory syndrome in children (MIS-C) post SARS-CoV-2 exposure.

    Active major bleeding, thrombocytopenia with antiplatelet antibody in presence of enoxaparin or heparin

    History of heparin-induced thrombocytopenia (HIT) within past 100 days or in presence of circulating antibodies

    Hypersensitivity to enoxaparin, heparin, pork products, benzyl alcohol (multiple dose formulations only) or other ingredients

    Hemorrhage (1-4%)

    Elevation of serum aminotransferases (6%)

    Fever (5-8%)

    Local site reactions (2-5%)

    Thrombocytopenia (3%)

    Nausea (3%)

    Anemia (2%)

    Ecchymosis (3%)

    Atrial fibrillation

    Heart failure

    Pulmonary edema

    Pneumonia

    Epidural or spinal hemorrhage and subsequent hematomas reported with the use of enoxaparin and epidural or spinal anesthesia/analgesia or spinal puncture procedures, resulting in long-term or permanent paralysis (see Black Box Warnings)

    Use with caution in patients with a bleeding diathesis, uncontrolled arterial hypertension or a history of recent gastrointestinal ulceration, diabetic retinopathy, renal dysfunction and hemorrhage

    Bleeding may occur; monitor patients with risk factors including congenital or acquired bleeding disorders, bacterial endocarditis, severe uncontrolled hypertension, hemorrhagic stroke, used shortly after brain, spinal, or ophthalmic surgery in patients treated concomitantly with platelet inhibitors or history of heparin induced thrombocytopenia, severe liver disease, diabetic retinopathy, patients undergoing invasive procedures, active ulcerative or angiodysplastic diseases, recent GI bleeding or ulceration

    To minimize risk of bleeding following PCI, achieve hemostasis, at puncture site after PCI; sheath can be removed immediately if closure device used; if manual compression used remove sheath 6 hr after last IV/SC dose of enoxaparin; additional doses not recommended until 6-8 hr after sheath removal; observe for signs of bleeding/hematoma formation

    Multidose formulation contains benzyl alcohol preservative, linked to fatal “gasping syndrome” in premature neonates

    Monitor for hyperkalemia (possibly from aldosterone suppression); mainly a concern among patients with risk factors including renal dysfunction, concomitant use of potassium sparing diuretics or potassium supplements

    Human data from a retrospective cohort study, suggest that enoxaparin does not increase risk of major developmental abnormalities

    Lactation: Excretion in milk unknown; not recommended

    Enoxaparin has a narrow therapeutic index, specific for the patient population and indication. The maximum dosage is individualized based on anti-factor Xa concentrations and assessment of efficacy and safety parameters.

    Enoxaparin sodium

    multidose vial

    • 100mg/mL (3mL vial)

    prefilled syringe

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