enoxaparin

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