Known brand names include Lovenox.
A low molecular weight heparin injected under the skin, usually once or twice a day. It prevents blood clots after surgery or during immobilizing illness, treats DVT with or without PE, and is used in unstable angina and heart attack.
High-alert medication. Low molecular weight heparin is named on the ISMP acute care high-alert list under anticoagulants.
Sources: [1]
The label does not describe a narrow therapeutic index or direct dosing by measured blood levels of the drug.
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Spinal or epidural hematomas. Patients on LMWH who receive neuraxial anesthesia or a spinal puncture can develop hematomas that cause long-term or permanent paralysis. Risk rises with indwelling epidural catheters, NSAIDs, platelet inhibitors or other anticoagulants, traumatic or repeated punctures, and prior spinal deformity or surgery. Monitor neurologic status often and treat compromise urgently.
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Protamine sulfate by slow IV injection only partly reverses it: 1 mg per 1 mg of enoxaparin given within the past 8 hours, or 0.5 mg per 1 mg if longer ago or if a second dose is needed. Anti-Xa activity is never fully neutralized (about 60% at most). After 12 hours protamine may not be needed. Protamine can cause severe hypotension and anaphylaxis-like reactions.
Sources: [1]
Sources: [1]
Doses come from the FDA label. Study tool, not for clinical decisions.
Creatinine clearance below 30 mL/min: prophylaxis 30 mg once daily; treatment doses 1 mg/kg once daily instead of every 12 hours. No change for clearance 30 to 80 mL/min, but watch closely for bleeding. Anti-Xa levels can guide therapy in renal impairment.
Not studied in hepatic impairment; the effect on exposure is unknown. No labeled dose change.
Sources: [1]
A low molecular weight heparin that works through antithrombin, with much more activity against factor Xa than against thrombin (IIa) compared with unfractionated heparin. It has a more predictable effect, so routine aPTT monitoring is not used. Anti-Xa half-life is about 4.5 to 7 hours, and the kidneys clear part of it.