Enoxaparin
Class: anticoagulant – low molecular weight heparin
Indications: prophylaxis of venous thromboembolic disease post-op and bedridden patients
Treatment of deep vein thrombosis and pulmonary embolism, unstable angina and myocardial infarction, prevention of thrombus during haemodialysis, duration of more than 30 days treatment
Contraindications/cautions: heparin allergy, active bleeding, recent haemorrhagic stroke, low platelets, renal impairment (adjust dose), spinal/epidural medication, prosthetic heart valve, history of gastrointestinal ulceration/bleed; haemorrhagic disorders; severe hypertension; peptic ulcer; hyperkalaemia
Adverse reactions: common: haemorrhage, haematoma, elevated LFTs; less common: allergic reactions, skin necrosis, thrombocytopenia
Metabolism/clearance: metabolised but cleared mainly by the kidneys so adjust dose in renal failure
Interactions:
- increased effect of enoxaparin may occur with other drugs that decrease blood clotting e.g. aspirin, clopidogrel, warfarin, heparin
- increased risk of bleeding when combined with NSAIDs e.g. diclofenac
- decreased effect of enoxaparin may occur with haemostats e.g. tranexamic acid, phytomenadione (vitamin K)
| Dosing: | ||
|---|---|---|
| oral: | not available | |
| subcut: | treatment (of DVT etc): | 1.5 mg/kg once a day or 1 mg/kg twice a day (lower in the obese and renal failure patients) |
| prophylaxis: | 20 to 40 mg once or twice a day | |
Syringe driver: not available
Mechanism of action: has high anti-Xa activity
Peak anti-Xa activity: 3 to 5 hours post inj
Notes:
- as the coagulation ability of cancer patients is altered it may be that low molecular weight heparins are a better choice in these patients than oral anticoagulants