Anticoagulation Service For Health Professionals
Enoxaparin Guidelines in USA/NQMI
Indications:
Generally same as for unfractionated heparin (UFH). Patients should have recent onset angina at rest, occurring within the prior 24 hrs for > 10 min, and have highly probable or known CAD.
Dose:
1 mg/kg subcutaneously q 12 hours in patients with normal renal function. First dose ASAP (e.g. in ER).
Patient also should receive ASA 100-325 mg/day
Length of Rx:
At least 48 hrs (usually 2-8 days). Discontinue when clinically indicated.
Pharmacokinetics:
Normal Renal Function:
Onset: Therapeutic anti-Xa activity achieved approx. 30 min post injection
Peak Activity: 3-5 hrs post injection
Duration of effect: Half-life 4.5 hrs; significant anti-Xa effect for 12 hrs
Impaired Renal Function:
Clearance of enoxaparin 2-fold slower in patients with creatinine clearance < 30 cc/min. If serum creatinine > or equal to 2 mg/dL, calculate creatinine clearance as follows:
Men: (140 - age) (body wt in kg) / 72 (serum creatinine in mg/dL)
Women: Formula for men x 0.85
If creatinine clearance > 30 cc/min, no need to adjust dose. If creatinine clearance < 30 cc/min, use UFH.
Monitoring:
Hemostatic testing (APTT, thrombin time, ACT) NOT necessary. In fact, these assays are only minimally affected by LMWH.
CBC and platelet count on admission. Check platelet count at least weekly and CBC q several days or as clinically indicated.
Serum creatinine on admission and prn subsequently if suspected change in renal function.
