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BLOOD AND BLOOD FORMING ORGANS › ANTITHROMBOTIC AGENTS › ANTITHROMBOTIC AGENTS › Heparin group
enoxaparin
B01AB05
Forms & Strengths
- Prefilled syringes: 30 mg/0.3 mL, 40 mg/0.4 mL, 60 mg/0.6 mL, 80 mg/0.8 mL, 100 mg/1 mL
- Graduated prefilled syringes: 120 mg/0.8 mL, 150 mg/1 mL
- Multi-dose vials: 300 mg/3 mL (100 mg/mL)
Adult Dosing
- DVT prophylaxis (abdominal/hip/knee surgery): 30 mg SC every 12 hours or 40 mg SC once daily
- DVT/PE treatment (acute, inpatient): 1 mg/kg SC every 12 hours OR 1.5 mg/kg SC once daily
- STEMI: 30 mg IV bolus plus 1 mg/kg SC, then 1 mg/kg SC every 12 hours
- Unstable angina/NSTEMI: 1 mg/kg SC every 12 hours with oral aspirin
Pediatric Dosing
- Neonates (VTE treatment): 0.5 to 1.5 mg/kg SC every 12 hours based on age and anti-Xa monitoring
- Pediatrics > 1 month to 18 years: 0.5 to 1 mg/kg SC every 12 hours targeting anti-Xa 0.5-1.0 units/mL
Indications
- Prophylaxis of deep vein thrombosis (DVT) in abdominal, hip replacement, knee replacement surgery, or medical illness
- Inpatient treatment of acute DVT with or without pulmonary embolism (PE)
- Outpatient treatment of acute DVT without PE
- Prophylaxis of ischemic complications in unstable angina and non-Q-wave myocardial infarction
- Treatment of acute ST-segment elevation myocardial infarction (STEMI)
Mechanism of Action
- Low molecular weight heparin with a mean molecular weight of 4,500 daltons
- Binds to antithrombin III, causing a conformational change that accelerates the inhibition of activated factor X (Factor Xa)
- Exerts a higher ratio of antifactor Xa to antifactor IIa activity (approximately 4:1) compared to unfractionated heparin
Contraindications
- Active major bleeding
- History of heparin-induced thrombocytopenia (HIT) or immune-mediated HIT within the past 100 days
- Hypersensitivity to enoxaparin, heparin, pork products, or benzyl alcohol
Adverse Reactions
- Bleeding (hemorrhage, major bleeding)
- Thrombocytopenia (including HIT)
- Injection site hematoma, ecchymosis, and pain
- Elevated liver transaminases (AST, ALT)
- Hypersensitivity reactions (pruritus, urticaria, anaphylaxis)
Drug Interactions
- Anticoagulants (warfarin, direct oral anticoagulants): increased bleeding risk
- Antiplatelet agents (aspirin, NSAIDs, P2Y12 inhibitors): increased risk of hemorrhage
- Thrombolytic agents: increased risk of major bleeding complications
Curated Content: Needs Vetting Before Put to Clinical Use