Therapeutic Classification: anticoagulants
Pharmacologic Classification: antithrombotics, low molecular weight heparins
Absorption: ~100% absorbed after SUBQ administration.
Distribution: Unknown.
Metabolism/Excretion: Metabolized in the liver, primarily renally eliminated. Clearance ↓ by 30% in renal impairment (CCr <30 mL/min).
Half-Life: Single dose: 4.5 hr; Repeat dosing: 7 hr.
Venous Thromboembolism Prophylaxis
- SC (Adults ): Knee replacement surgery: 30 mg every 12 hr starting 12–24 hr after surgery for 7–10 days; Hip replacement: 30 mg every 12 hr starting 12–24 hr after surgery or 40 mg once daily starting 12 hr before surgery (either dose may be continued for 7–14 days; continued prophylaxis with 40 mg once daily may be continued for up to 3 wk); Abdominal surgery: 40 mg once daily starting 2 hr before surgery and then continued for 7–12 days or until ambulatory (up to 14 days); Medical patients with acute illness: 40 mg once daily for 6–14 days.
- SC (Infants and Children ≥2 mo —18 yr): 0.5 mg/kg every 12 hr.
- SC (Infants 1–2 mo): 0.75 mg/kg every 12 hr.
Renal Impairment
- SC (Adults ): CCr <30 mL/min: 30 mg once daily.
Treatment of Deep Vein Thrombosis/Pulmonary Embolism
- SC (Adults ): Outpatient: 1 mg/kg every 12 hr. Warfarin should be started within 72 hr; enoxaparin may be continued for a minimum of 5 days and until therapeutic anticoagulation with warfarin is achieved (INR >2 for 2 consecutive days); Inpatient: 1 mg/kg every 12 hr or 1.5 mg/kg every 24 hr. Warfarin should be started within 72 hr; enoxaparin may be continued for a minimum of 5 days or until therapeutic anticoagulation with warfarin is achieved (INR >2 for two consecutive days).
- SC (Infants and Children ≥2 mo —18 yr): 1 mg/kg every 12 hr.
- SC (Infants 1–2 mo): 1.5 mg/kg every 12 hr.
Renal Impairment
- SC (Adults ): CCr <30 mL/min: 1 mg/kg once daily.
Unstable Angina/Non-ST-Segment-Elevation Myocardial Infarction
- SC (Adults ): 1 mg/kg every 12 hr for 2–8 days (with aspirin).
Renal Impairment
- SC (Adults ): CCr <30 mL/min: 1 mg/kg once daily.
ST-Segment-Elevation Myocardial Infarction
- IV SC (Adults <75 yr): Administer single IV bolus of 30 mg plus 1 mg/kg SUBQ dose (maximum of 100 mg for first 2 doses only), followed by 1 mg/kg SUBQ every 12 hr. The usual duration of treatment is 2–8 days. In patients undergoing percutaneous coronary intervention, if last SUBQ dose was <8 hr before balloon inflation, no additional dosing needed; if last SUBQ dose was ≥8 hr before balloon inflation, administer single IV bolus of 0.3 mg/kg.
- SC (Adults ≥75 yr): 0.75 mg/kg every 12 hr (no IV bolus needed) (maximum of 75 mg for first 2 doses only; no initial bolus). The usual duration of treatment is 2–8 days.
Renal Impairment
- SC (Adults <75 yr): CCr <30 mL/min: Single IV bolus of 30 mg plus 1 mg/kg SUBQ dose, followed by 1 mg/kg SUBQ once daily.
Renal Impairment
- SC (Adults ≥75 yr): CCr <30 mL/min: 1 mg/kg once daily (no initial bolus).
