Enoxaparin Sodium
Mechanism :
The mechanism of action of enoxaparin is antithrombin-dependent. It acts mainly by accelerating the rate of the neutralization of certain activated coagulation factors by antithrombin, but other mechanisms may also be involved. The antithrombotic effect of enoxaparin is well correlated to the inhibition of factor Xa. Enoxaparin interacts with Antithrombin III, Prothrombin and Factor X. Enoxaparin binds to and accelerates the activity of antithrombin III. By activating antithrombin III, enoxaparin preferentially potentiates the inhibition of coagulation factors Xa and IIa.
Indication :
- Thromboembolism prophylaxis
- Thromboembolism treatment.
Contraindications :
Enoxaparin is contraindicated in patients with active major bleeding, in patients with thrombocytopenia associated with a positive in vitro test for anti-platelet antibody in the presence of enoxaparin sodium, or in patients with hypersensitivity to enoxaparin. Patients with known hypersensitivity to heparin or pork products should not be treated with enoxaparin injection or any of its constituents.
Dosing :
Thromboembolism prophylaxis:
<2 months:
0.75 mg/kg SC every 12 hours.
>2 months:
0.5 mg/kg SC every 12 hours.
Thromboembolism treatment:
<2 months:
1.5 mg/kg SC every 12 hours.
>2 months:
1 mg/kg SC every 12 hours.
Adjust dose to anti Xa levels 0.1-0.3 units/ml. Discontinue if platelet count <100,000 cells/cumm.
Adverse Effect :
Hemorrhage, skin necrosis, Heparin-induced thrombocytopenia, hyperkalemia, osteoporosis and hypersensitivity reactions.
Interaction :
Anticoagulants, Platelet Inhibitors Including Acetylsalicylic Acid, Salicylates, NSAIDs, Dipyridamole, or Sulfinpyrazone: Agents which may enhance the risk of hemorrhage should be discontinued or used with extreme caution.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 50-80 | Dose as in normal renal function |
| 30-50 | Dose as in normal renal function. Monitor carefully |
| <30 | Treatment: 1 mg/kg daily. Prophylaxis: 20 mg daily. See ‘Other Information |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Not dialysed. Dose as in GFR<30 mL/min |
| HD | Not dialysed. Dose as in GFR<30 mL/min |
| HDF/High flux | Dialysed. Dose as in GFR<30 mL/ min |
| CAV/VVHD | Not dialysed. Dose as in GFR=30– 50 mL/min |
Hepatic Dose :
No dosage adjustments are recommended.