Enoxaparin sodium is a low molecular weight heparin (LMWH) derived from porcine intestinal mucosa. It is an anticoagulant that acts by potentiating the inhibition of Factor Xa and thrombin (Factor IIa) by antithrombin III. The 60mg strength (6000 IU anti-Factor Xa activity) is primarily used for the prophylaxis and treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), and for the management of acute coronary syndromes (ACS) in the Indian context.
Adult: **DVT Prophylaxis (Moderate Risk):** 40 mg (4000 IU) SC once daily. **DVT Prophylaxis (High Risk - e.g., orthopedic surgery):** 40 mg SC once daily or 30 mg SC twice daily. **Treatment of DVT/PE:** 1 mg/kg SC every 12 hours OR 1.5 mg/kg SC once daily. **ACS (Unstable Angina/Non-STEMI):** 1 mg/kg SC every 12 hours (concomitant aspirin). **Note:** 60mg dose is often used for treatment in patients weighing ~60 kg or as part of a specific regimen.
Note: For subcutaneous use only. Administer by deep SC injection, preferably in the abdominal wall. Patient should be lying down. Pinch a skin fold between thumb and forefinger and insert the full length of the needle at a 90-degree angle. Do not aspirate before or massage after injection. Rotate injection sites daily. Prefilled syringes are single-use. Do not mix with other injections.
Enoxaparin binds to and potentiates the activity of antithrombin III (AT-III), a natural inhibitor of coagulation proteases. This binding causes a conformational change in AT-III, dramatically accelerating its rate of inhibition of activated coagulation Factor X (Xa). It has a higher ratio of anti-Factor Xa to anti-Factor IIa (thrombin) activity (approximately 3.8:1) compared to unfractionated heparin.
Pregnancy: **Category B (US FDA).** Does not cross the placental barrier in significant amounts. Considered the anticoagulant of choice for treatment and prophylaxis of VTE in pregnancy. Dose adjustment may be needed (monitor anti-Factor Xa levels).
Driving: No known effects on driving ability. However, dizziness or headache reported as rare side effects.
| Oral Anticoagulants (Warfarin, Acenocoumarol) | Increased risk of bleeding. Monitor INR closely during overlap therapy. | Major |
| Antiplatelets (Aspirin, Clopidogrel, Ticagrelor) | Additive antiplatelet effect increases bleeding risk. Often used together in ACS but with caution. | Major |
| NSAIDs (Diclofenac, Ibuprofen) | Increased risk of gastrointestinal bleeding and general hemorrhage. | Major |
| Thrombolytics (Streptokinase) | Profound increase in bleeding risk. | Major |
| SSRIs (Sertraline, Escitalopram) | May impair platelet function, increasing bleeding risk. | Moderate |
| Digoxin | No significant pharmacokinetic interaction. | Minor |