II. Indications
- Venous Thromboembolism (DVT, PE) prophylaxis and treatment
- Acute Coronary Syndrome
III. Mechanism
IV. Dosing: VTE Prophylaxis Dose
-
Creatinine Clearance (CrCl) >30 ml/min
- Normal Dosing (BMI 18.5 to 40 kg/m2 or weight <100 kg)
- Enoxaparin (Lovenox) 40 mg SQ daily for medical inpatients or abdominal surgery
- Enoxaparin (Lovenox) 30 mg SQ every 12 hours if s/p knee or hip replacement
- Morbid Obesity (BMI >40 kg/m2 or weight >100 kg)
- BMI 40 to 49 kg/m2: Enoxaparin 40 mg SQ twice daily
- BMI >=50 kg/m2: Enoxaparin 60 mg SQ twice daily
- Low Body Weight (BMI <18.5 kg/m2 or weight <50 kg)
- Enoxaparin 30-40 mg SQ once daily
- Normal Dosing (BMI 18.5 to 40 kg/m2 or weight <100 kg)
-
Creatinine Clearance (CrCl) 15-30 ml/min (or weight <40 kg)
- Enoxaparin (Lovenox) 30 mg SQ daily
-
Creatinine Clearance (CrCl) <15 ml/min
- Enoxaparin (Lovenox) is contraindicated
- Use Unfractionated Heparin 5000 units SQ every 8-12 hours
V. Dosing: Therapeutic Dose
-
Creatinine Clearance (CrCl) >30 ml/min
- Normal Dosing (BMI <40 kg/m2 or weight <100 kg)
- Enoxaparin (Lovenox) 1 mg/kg SQ every 12 hours OR
- Enoxaparin 1.5 mg/kg SQ every 24 hours for inpatients with acute VTE (DVT, PE)
- Morbid Obesity (BMI >40 kg/m2 or weight >100 kg)
- Enoxaparin (Lovenox) 0.75 to 0.85 mg/kg SQ every 12 hours
- Normal Dosing (BMI <40 kg/m2 or weight <100 kg)
-
Creatinine Clearance (CrCl) 15-30 ml/min (or weight <40 kg)
- Unfractionated Heparin is preferred
- As an alternative, Enoxaparin (Lovenox) 1 mg/kg SQ once daily for up to 7 days
-
Creatinine Clearance (CrCl) <15 ml/min
- Enoxaparin (Lovenox) is contraindicated
- Use Unfractionated Heparin 5000 units SQ every 8-12 hours
VI. Safety
- Use in pregnancy when benefit outweighs the risk
- Considered safe in Lactation
- Factor Xa levels are not accurate for monitoring LMWH SQ Injection thereapeutic range
VII. Efficacy
VIII. Resources
IX. References
- Dummer (2009) Perioperative Guidelines
- Douketis (2008) Chest 133(6 Suppl):299S-339S [PubMed]
- (2025) Presc Lett 32(2): 11