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 80mg strength (approximately 8000 IU anti-Factor Xa activity) is a standard therapeutic dose used for the treatment and prophylaxis of thromboembolic disorders. It offers predictable pharmacokinetics, allowing for once- or twice-daily subcutaneous administration without the need for routine coagulation monitoring in most patients.
Adult: Treatment of DVT/PE: 1 mg/kg (100 IU/kg) subcutaneously every 12 hours OR 1.5 mg/kg (150 IU/kg) subcutaneously once daily. Prophylaxis in Medical/Surgical Patients: 40 mg (4000 IU) subcutaneously once daily. Unstable Angina/NSTEMI: 1 mg/kg every 12 hours subcutaneously with aspirin. The 80mg dose is often used for patients weighing ~80kg in the treatment regimen.
Note: For subcutaneous use only. Administer by deep subcutaneous injection. 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 into the skin fold. Common sites: abdominal wall (at least 2 inches from umbilicus), outer thigh. Rotate sites daily. Do not aspirate before injection. Do not massage the site. Do not mix with other injections. Pre-filled syringes are single-use only.
Enoxaparin exerts its anticoagulant effect by binding to and potentiating the natural inhibitor of coagulation, antithrombin III (ATIII). This binding causes a conformational change in ATIII, dramatically accelerating its ability to inactivate coagulation enzymes, particularly Factor Xa and, to a lesser extent, Factor IIa (thrombin). The ratio of anti-Factor Xa to anti-Factor IIa activity is approximately 3.8:1, which is higher than unfractionated heparin, contributing to a more predictable anticoagulant response.
Pregnancy: Category B: Animal studies have shown no risk, but no adequate, well-controlled studies in pregnant women. Used when clearly needed (e.g., treatment of VTE in pregnancy). Does not cross the placenta in significant amounts. Preferred over warfarin in pregnancy. Monitor platelets.
Driving: No known effects on driving ability. However, dizziness reported as a side effect; patients should be cautious.
| Oral Anticoagulants (Warfarin, Acenocoumarol) | Increased risk of bleeding. Monitor INR closely during overlap therapy. | Major |
| Antiplatelet Agents (Aspirin, Clopidogrel, Ticagrelor) | Additive risk of bleeding. Often used therapeutically in ACS, but risk must be managed. | Major |
| NSAIDs (Ibuprofen, Diclofenac) | Increased risk of gastrointestinal bleeding and general hemorrhage. | Major |
| Thrombolytics (Streptokinase, Alteplase) | Profound increase in bleeding risk. | Major |
| SSRIs (Sertraline, Escitalopram) | May impair platelet function, increasing bleeding risk. | Moderate |
| Herbal Supplements (Ginkgo biloba, Garlic, Ginseng) | Potential increased bleeding risk. | Moderate |