Enoxaparin

LMWH·Haematology - Anticoagulants & Haemostatics

VTE prophylaxis, treatment of DVT/PE, ACS (NSTEMI/STEMI bridging)

PBSLMWHClexane20 mgS4+1

Prophylaxis

40 mg SC OD

Half-life

4-5 h

Bleeding Risk

HIGH

HIT Risk

MONITOR PLT

Rapid Summary

Overview

Low Molecular Weight Heparin (LMWH). The workhorse injectable anticoagulant for DVT prophylaxis on the ward and 'bridging' therapy.

Maximum Dose

Max 1.5 mg/kg OD or 1 mg/kg BD (Therapeutic dose).

Clinical Focus

Requires aggressive dose reduction in renal impairment, as it is exclusively renally cleared.

Bottom Line

Enoxaparin is the standard low-molecular-weight heparin for VTE prophylaxis and treatment, but requires dose adjustment in renal impairment and obesity, and monitoring via anti-Xa levels.

Formulation & Access

Brand Names

Clexane

Parenteral

Pre-filled syringes for SC injection (20 mg, 40 mg, 60 mg, 80 mg, 100 mg, 120 mg, 150 mg).

Prescribing & PBS

Unrestricted General Benefit (S4).

Indications & Use

Primary

PBSTGA

VTE prophylaxis, treatment of DVT/PE, ACS (NSTEMI/STEMI bridging).

Clinical Place

Universal ward prophylaxis. Used to 'bridge' patients initiating Warfarin.

Quick reference

Class & Role

LMWH — Low Molecular Weight Heparin (LMWH).

Route / Formulation

Pre-filled syringes for SC injection (20 mg, 40 mg, 60 mg, 80 mg, 100 mg, 120 mg, 150 mg). (Clexane)

Usual Dose & Max

SC 40 mg OD. Max 1.5 mg/kg OD or 1 mg/kg BD (Therapeutic dose).

Key Indication Doses

VTE Prophylaxis (Medical): SC 40 mg OD. VTE Prophylaxis (Renal): SC 20 mg OD if eGFR < 30. Therapeutic (VTE/PE/ACS): SC 1 mg/kg BD OR 1.5 mg/kg OD. Therapeutic (Renal): SC 1 mg/kg OD if eGFR < 30.

Best Uses

Enoxaparin is the standard low-molecular-weight heparin for VTE prophylaxis and treatment, but requires dose adjustment in renal impairment and obesity, and monitoring via anti-Xa levels.

Avoid / Cautions

Active bleeding, history of HIT, planned epidural/spinal anaesthesia within 12-24 hours. Drug of choice for anticoagulation in Pregnancy (does not cross placenta).

Key Risks

Haematological: Haemorrhage. HIGH — Heparin-Induced Thrombocytopenia (HIT). Neurological: Epidural/Spinal hematoma (can cause permanent paralysis if given too close to an epidural block/removal). Metabolic: Hyperkalemia (mild aldosterone suppression).

Key Interactions

Other anticoagulants, high-dose Aspirin, NSAIDs.

Monitoring

U&E/eGFR (calculate dose). Monitor FBC (platelets) on days 4-14 to screen for HIT. Routine aPTT monitoring is useless. If monitoring is required (e.g., severe obesity, pregnancy), use Anti-Xa levels.

Clinical Pearl

Never administer a therapeutic dose of Enoxaparin within 24 hours of an epidural insertion or removal. The resultant hematoma will compress the spinal cord and cause paraplegia.

Access

Clexane

Brand: Clexane

Enoxaparin

LMWH·Haematology - Anticoagulants & Haemostatics

VTE prophylaxis, treatment of DVT/PE, ACS (NSTEMI/STEMI bridging)

PBSLMWHClexane20 mgS4+1

Prophylaxis

40 mg SC OD

Half-life

4-5 h

Bleeding Risk

HIGH

HIT Risk

MONITOR PLT

Rapid Summary

Overview

Low Molecular Weight Heparin (LMWH). The workhorse injectable anticoagulant for DVT prophylaxis on the ward and 'bridging' therapy.

Maximum Dose

Max 1.5 mg/kg OD or 1 mg/kg BD (Therapeutic dose).

Clinical Focus

Requires aggressive dose reduction in renal impairment, as it is exclusively renally cleared.

Bottom Line

Enoxaparin is the standard low-molecular-weight heparin for VTE prophylaxis and treatment, but requires dose adjustment in renal impairment and obesity, and monitoring via anti-Xa levels.

Formulation & Access

Brand Names

Clexane

Parenteral

Pre-filled syringes for SC injection (20 mg, 40 mg, 60 mg, 80 mg, 100 mg, 120 mg, 150 mg).

Prescribing & PBS

Unrestricted General Benefit (S4).

Indications & Use

Primary

PBSTGA

VTE prophylaxis, treatment of DVT/PE, ACS (NSTEMI/STEMI bridging).

Clinical Place

Universal ward prophylaxis. Used to 'bridge' patients initiating Warfarin.

Quick reference

Class & Role

LMWH — Low Molecular Weight Heparin (LMWH).

Route / Formulation

Pre-filled syringes for SC injection (20 mg, 40 mg, 60 mg, 80 mg, 100 mg, 120 mg, 150 mg). (Clexane)

Usual Dose & Max

SC 40 mg OD. Max 1.5 mg/kg OD or 1 mg/kg BD (Therapeutic dose).

Key Indication Doses

VTE Prophylaxis (Medical): SC 40 mg OD. VTE Prophylaxis (Renal): SC 20 mg OD if eGFR < 30. Therapeutic (VTE/PE/ACS): SC 1 mg/kg BD OR 1.5 mg/kg OD. Therapeutic (Renal): SC 1 mg/kg OD if eGFR < 30.

Best Uses

Enoxaparin is the standard low-molecular-weight heparin for VTE prophylaxis and treatment, but requires dose adjustment in renal impairment and obesity, and monitoring via anti-Xa levels.

Avoid / Cautions

Active bleeding, history of HIT, planned epidural/spinal anaesthesia within 12-24 hours. Drug of choice for anticoagulation in Pregnancy (does not cross placenta).

Key Risks

Key Interactions

Other anticoagulants, high-dose Aspirin, NSAIDs.

Monitoring

U&E/eGFR (calculate dose). Monitor FBC (platelets) on days 4-14 to screen for HIT. Routine aPTT monitoring is useless. If monitoring is required (e.g., severe obesity, pregnancy), use Anti-Xa levels.

Clinical Pearl

Never administer a therapeutic dose of Enoxaparin within 24 hours of an epidural insertion or removal. The resultant hematoma will compress the spinal cord and cause paraplegia.

Access

Clexane

Brand: Clexane