Indications
Cardiac
Pulmonary
Other Indications for Anticoagulation
Pharmacology
- Low Molecular Weight Heparin
Administration
- SQ (DVT Prophylaxis): 40 mg qday or xxx
- SQ (Full Anticoagulation): xxx
Dose Adjustment
Effect on Anticoagulation Tests
- Prothrombin Time (PT)/International Normalized Ratio (INR) (see Prothrombin Time, [[Prothrombin Time]]): no effect
- Enoxaparin is an indirect thrombin inhibitor and should theoretically prolong the INR: however, most INR assay reagents contain heparin-binders which block the effect of heparin (or similar agents) at concentrations <1 unit/mL -> therefore, at heparin concentration of >1 unit/mL, the INR may be prolonged
- Partial Thromboplastin Time (PTT) (see Partial Thromboplastin Time, [[Partial Thromboplastin Time]]): no effect-prolonged
- Anti-Factor Xa (see Anti-Factor Xa, [[Anti-Factor Xa]]): prolonged
Management of Enoxaparin Therapy Prior to Surgery/Procedure
- Recommendations (Chest Antithrombotic Therapy and Prevention of Thrombosis 2012 Guidelines) [MEDLINE]
- Administer Last Dose of Enoxaparin 24 hrs Prior to Surgery/Procedure (Grade 2C Recommendation)
Post-Operative Resumption of Enoxaparin Following Surgery/Procedure with High Bleeding Risk
- Recommendations (Chest Antithrombotic Therapy and Prevention of Thrombosis 2012 Guidelines) [MEDLINE]
- Resume Enoxaparin 48-72 hrs Following Surgery/Procedure (Grade 2C Recommendation)
Adverse Effects
Hemorrhagic Adverse Effects
- Adrenal Hemorrhage (see Adrenal Insufficiency, [[Adrenal Insufficiency]])
- Diffuse Alveolar Hemorrhage (DAH) (see Diffuse Alveolar Hemorrhage, [[Diffuse Alveolar Hemorrhage]]
- Epistaxis (see Epistaxis, [[Epistaxis]])
- Gastrointestinal Hemorrhage (see Gastrointestinal Hemorrhage, [[Gastrointestinal Hemorrhage]])
- Intracerebral Hemorrhage (Hemorrhagic Cerebrovascular Accident) (see Intracerebral Hemorrhage, [[Intracerebral Hemorrhage]])
- Intracranial Epidural Hematoma (see Intracranial Epidural Hematoma, [[Intracranial Epidural Hematoma]])
- Retroperitoneal Hemorrhage (see Retroperitoneal Hemorrhage, [[Retroperitoneal Hemorrhage]])
- Spinal Epidural Hematoma (see Spinal Epidural Hematoma, [[Spinal Epidural Hematoma]])
- Subarachnoid Hemorrhage (SAH) (see Subarachnoid Hemorrhage, [[Subarachnoid Hemorrhage]])
- Subdural Hematoma (SDH) (see Subdural Hematoma, [[Subdural Hematoma]])
Other Adverse Effects
References
- Executive summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141(2 Suppl):7S-47S. doi: 10.1378/chest.1412S3 [MEDLINE]