Indications

Cardiac

• Acute Coronary Syndrome (see Coronary Artery Disease, [[Coronary Artery Disease]])
• Atrial Fibrillation (see Atrial Fibrillation, [[Atrial Fibrillation]])

Pulmonary

• Venous Thromboembolism
  • Acute Pulmonary Embolism (PE) (see Acute Pulmonary Embolism, [[Acute Pulmonary Embolism]])
  • Deep Venous Thrombosis (DVT) Prophylaxis (see Deep Venous Thrombosis, [[Deep Venous Thrombosis]])

Other Indications for Anticoagulation

• xxxx

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Pharmacology

• Low Molecular Weight Heparin

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Administration

• SQ (DVT Prophylaxis): 40 mg qday or xxx
• SQ (Full Anticoagulation): xxx

Dose Adjustment

• Hepatic: xxx
• Renal: xxx

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)

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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

• xxx

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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]