Section 13 · Monograph
Enoxaparin
Reviewed Nov 2026FDA label
LovenoxLow-molecular-weight heparin
- Forms
- SC syringe: 30, 40, 60, 80, 100, 120, 150mg
- Dose
- VTE prophylaxis: 40mg SC once daily (30mg once daily if CrCl under 30mL/min); neuro-ICU start once hemorrhage is stable per guidelines
- MOA
- Potentiates antithrombin; inhibits factor Xa more than IIa
Black Box Warning
- Epidural or spinal hematomas may occur in patients receiving enoxaparin with neuraxial anesthesia or spinal puncture, potentially causing long-term or permanent paralysis; risk is increased by indwelling catheters, concomitant NSAIDs, platelet inhibitors or other anticoagulants, traumatic or repeated puncture, and history of spinal deformity or surgery
Indications
- Prophylaxis of deep vein thrombosis after abdominal, hip or knee surgery and in medical patients with restricted mobilityFDA-labeled
- Treatment of acute DVT with or without pulmonary embolism; unstable angina and NSTEMI; STEMIFDA-labeled
Mechanism of Action
- Low-molecular-weight heparin that potentiates antithrombin, preferentially inhibiting factor Xa over thrombin
Full Dosing
Adult / usual
- Neurocritical care: start once hemorrhage (ICH, SAH, traumatic) is stable on repeat imaging, typically 24-72 hours, per guidelines
Renal
- VTE prophylaxis: 40mg SC once daily (30mg SC once daily if CrCl below 30mL/min); some trauma/orthopedic protocols use 30mg twice daily
- Hold before and after neuraxial procedures according to label timing; consider anti-Xa monitoring in obesity, pregnancy and renal impairment
Contraindications
- Active major bleeding
- History of immune-mediated heparin-induced thrombocytopenia (within the past 100 days or with circulating antibodies)
- Hypersensitivity to enoxaparin, heparin or pork products
Drug Interactions
- Anticoagulants, antiplatelets, NSAIDs, SSRIs and thrombolytics increase bleeding risk
- Drugs that raise potassium add to heparin-induced hyperkalemia
Adverse Effects
- Bleeding including intracranial and spinal hematoma
- Heparin-induced thrombocytopenia (less than unfractionated heparin)
- Injection-site hematoma
- Elevated transaminases, hyperkalemia
Monitoring Parameters
- Platelet count and hemoglobin
- Serum creatinine and CrCl
- Neurologic checks for spinal hematoma after neuraxial procedures; anti-Xa when indicated
Pregnancy & Lactation
- Preferred anticoagulant in pregnancy (does not cross the placenta); use preservative-free forms when possible
- Minimal oral absorption; compatible with breastfeeding