Disclaimer to the Online Edition
This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.
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