enoxaparin
Indication
- Treatment and prophylaxis of thromboembolism
Dosage Guidelines
| Age less than or equal to 2 months | Age greater than 2 months |
Initial treatment dose | 1.75 mg/kg/dose SUBCUTANEOUS q12 hours | 1 mg/kg/dose SUBCUTANEOUS q12 hours |
Initial prophylaxis dose | 0.75 mg/kg/dose SUBCUTANEOUS q12 hours or 1.5 mg/kg/dose SUBCUTANEOUS q24 hours | 0.5 mg/kg/dose SUBCUTANEOUS q12 hours or 1 mg/kg/dose SUBCUTANEOUS q24 hours |
Maximum treatment dose | 3 mg/kg/dose SUBCUTANEOUS q12 hours | 2 mg/kg/dose SUBCUTANEOUS q12 hours |
Note: Doses 10 mg or less may only be ordered in 0.5 mg or 1 mg increments to allow for a measurable volume
Administration
- Subcutaneous
Adverse Effects
- Bleeding, thrombocytopenia, osteoporosis with long-term use
Comments
- Prior to starting enoxaparin therapy, draw blood for CBC
- Anti-factor Xa (Heparin Assay) monitoring:
- Target for treatment is 0.5 – 1 units/mL
- A microtainer is used to collect the sample
- Draw blood from a fresh venipuncture. THERE MUST BE NO CONTAMINATION from unfractionated heparin (example: from an arterial or central venous line).
- Initial level: On day 1 or day 2, a blood sample should be drawn 4 hours after the subcutaneous administration of the morning dose.
- Adjust dose according to nomogram
- Once therapeutic, monitor anti-factor Xa (Heparin Assay) level once weekly
- Antidote for enoxaparin overdose: Protamine sulfate 1 mg for every 1 mg IV direct given slowly over 3-5 minutes for every 1 mg enoxaparin, within 8 hours of last dose. Use protamine 0.5 mg per 1 mg enoxaparin if between 8 to 12 hours after last dose. Protamine may not be required if greater than 12 hours after enoxaparin administration.
Enoxaparin Nomogram
Adjust the dose of enoxaparin according to the following:
Anti-Factor Xa Level (units/mL) | Hold next dose? | Dose change* | Repeat Anti-Factor Xa Level |
Less than 0.35 | No | Increase by 25% - 50% | 4 hours post next morning dose |
0.35 – 0.49 | No | Increase by 25% - 50% | 4 hours post next morning dose |
0.5 - 1 | No | 0 | Once weekly, 4 hours post morning dose |
1.01 – 1.6 | No | Decrease by 20% | 4 hours post next morning dose |
Greater than 1.6 | Yes – until level is less than 0.5 | Decrease by 40% | Trough level prior to next dose and if not less than 0.5, repeat before each dose is due |
*Dose adjustment must be ordered in 0.5 mg increments for doses less than 5 mg
Supplied As
- 100 mg/mL syringes prepared by Pharmacy
- For doses less than 10 mg, supplied by Pharmacy in an insulin syringe (each gradient of 1 unit is equal to 1 mg of enoxaparin)
References
Lexicomp Sick Kids, Lexicomp Pediatric and Neonatal