enoxaparin
Brand: Lovenox
ISMP High Alert Prototype Drug
Drug Class: anticoagulant
Drug Family: anticoagulant
Subclass: low molecular weight heparin (LMWH)
Organ Systems: cardiovascularhematology-oncology
Mechanism of Action
LMWH with high anti-Xa:anti-IIa ratio (3.7:1); more predictable PK than UFH; predominantly inhibits Xa via AT-III.
factor Xa (predominant via AT-III)factor IIa (minor)
Indications
- DVT/PE treatment and prevention
- ACS (NSTEMI/STEMI)
- thromboprophylaxis
- bridging
Contraindications
- active major bleeding
- HIT history (cross-reactivity)
- severe renal impairment (adjust dose)
Adverse Effects
Common
- injection site bruising
- elevated LFTs
Serious
- major hemorrhage
- HIT (10x less than UFH)
- hyperkalemia
Pharmacokinetics (ADME)
| Absorption | 92% SC bioavailability |
| Distribution | mainly intravascular |
| Metabolism | desulfation/depolymerization (not CYP) |
| Excretion | renal |
| Half-life | 4.5-7 hours |
| Onset | 3-5 hours SC |
| Peak | 3-5 hours |
| Duration | ~12 hours |
| Protein Binding | ~0% plasma |
| Vd | 4.3 L |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| antiplatelet agents | increased bleeding risk | major |
| protamine | partial reversal 60-80% only | moderate |
Nursing Considerations
- Therapeutic: 1 mg/kg SC q12h or 1.5 mg/kg SC daily
- Prophylactic: 30-40 mg SC daily
- Renal dose adjustment: CrCl <30 use 1 mg/kg SC daily for therapeutic
- Anti-Xa monitoring in renal impairment, obesity (BMI >40), pregnancy
- No routine aPTT monitoring needed
Clinical Pearls
- More predictable PK vs UFH: no aPTT monitoring routinely needed
- Lower HIT risk (10x) than UFH: shorter chains bind PF4 less
- ESSENCE/TIMI 11B: superior to UFH for NSTEMI outcomes
Safety Profile
Pregnancy safe
Lactation use-with-caution
Renal Adjustment Required
Hepatic Adjustment Not required
TDM Not required
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.